Apraxia of Speech

Question 0

Different from Dysarthria

Answer 0

Speech errors not caused by muscle weakens, abnormal muscle tone, reduced range of movement, or decreased muscle steadiness

Errors in this disorder are caused by a deficit in the ability to accurately sequence the movements needed to produce speech sounds

Disorder of motor planning and sequencing

Question 1

Similar to Dysarthria

Answer 1

Neurologic deficit
Affects speech production
Treated by SLP

Question 2

The term apraxia comes from the Greek word________ which means __________

Answer 2

‘praxis’

‘performance of action’.

Question 3

There are _______ main types of apraxia

Answer 3

two

Question 4

Two main types of apraxia

Answer 4

–Ideational apraxia

–Ideomotor apraxia

Question 5

–Ideational apraxia

Answer 5

•Uncommon; disturbance in conception of object or gesture. It co-occurs with aphasia at times.

Question 6

–Ideomotor apraxia

Answer 6

• Disturbance in performance of movements needed to use object, make gesture, sequence movements
• Typically affects voluntary movements
• Subcategories: limb apraxia, nonverbal oral apraxia, apraxia of speech
• Affects voluntary movements more often than spontaneous movements.
• Movement sequencing is easier when actually manipulating an object as compared with only pantomiming its use.
• Completing a movement sequence is easy when a gestural command is provided rather than a verbal command.
• Movement sequencing errors can be inconsistent

Question 7

•Limb apraxia:

Answer 7

Inability to sequence the movements of the arms, legs, hands, or feet during voluntary action.

Question 8

•Nonverbal oral apraxia:

Answer 8

Deficit in the ability to sequence nonverbal, voluntary movements of the tongue.

Question 9

•Apraxia of speech (AOS):

Answer 9

Deficit in the ability to select and sequence motor commands needed to correctly position the articulators during the voluntary production of phonemes.

Question 10

Definition of Apraxia of Speech

Answer 10

•Pure apraxia of speech rare
•Disorder of motor sequencing
•Not caused by:
–Muscle weakness
–Abnormal muscle tone
–Reduced range of movement
–Decreased muscle steadiness

Question 11

Neurological Basis of AOS

Answer 11

•Motor speech programmer
–Neural network in brain that sequences motor movements needed to produce speech
–First analyzes linguistic, motor, sensory, and emotional information
–Near perisylvian area of left hemisphere

Question 12

Causes of AOS

Answer 12

•Disorders that damage motor speech programmer
•Caused by:
–Stroke (most common)
–Degenerative disease
–Trauma
–Tumor

Question 13

Speech Characteristics of AOS

Answer 13

• Primarily disorder of articulation and prosody
• Slow, labored, halting speech
• Instances of groping
• Some say inconsistent speech errors, but research suggests fairly consistent for location and type in repeated trials

Question 14

•Severe and mild apraxia demonstrate fewest characteristics

Answer 14

•Errors of:
–Articulation: most common
–Prosody: frequently abnormal
–Respiration: may have difficulty taking deep breath on command
–Resonance and phonation: seldom issues

Question 15

Articulation errors in AOS

Answer 15

• Substitutions of phoneme for another
• Placement errors
• Substitution of a voiceless phoneme for a voice phoneme
• Some substitution errors can be perseverative
• Fricative and affricates are more often in errors
• Consonant clusters are more likely to be in error
• Articulation is more accurate on real words than nonsense words.
• Voluntary speech more difficult than automatic speech

Question 16

Prosodic errors in AOS

Answer 16

• Rate of connected speech is slower than normal
• Equal stress is often placed on all syllables in an utterance
• Silent pauses may occur at the initiation of a word, syllables, or between words.
• Normal variations of pitch and loudness is utterances may be reduced.

Question 17

Assessment of AOS

Answer 17

•Sequential motion rate task (SMRs)
–Sensitive assessment, especially when compared with alternating motion rate (AMR) tasks
•Conversational speech and reading aloud
–Determine effects of prosody
•Repeating words of increasing length
•Reading or repeating low-frequency, multisyllabic words in isolation or sentences

1. Diadochokinetic Rate
2. Increasing Word Length
3. Limb Apraxia and Oral Apraxia
4. Latency Time and Utterance Time
   for Polysyllabic Words
5. Repeated Trials Test
6. Inventory of Articulation
   Characteristics of Apraxia

Question 18

Differential Diagnosis of Apraxia of Speech

Answer 18

•Diagnosis only when determined significant number of patient’s speech errors match those known to apraxia of speech

Question 19

•Four categories of behaviors determine correct diagnosis (Wambaugh et al., 2006a)

Answer 19

–Primary clinical characteristics
–Nondiscriminitive clinical characteristics
–Behaviors usually found in disorders other than apraxia of speech
–Behaviors that rule out presence of apraxia of speech

Question 20

Primary clinical characteristics

Answer 20

• The patient demonstrates prosody abnormalities
• Has a slow speech rate characterized by lengthened production of vowels, consonants, or both.
• Distorted production of consonants and vowels
• Phoneme substitutions that are distorted
• Articulation errors during repeated utterances that generally are consistent for type of error and for location

Question 21

Nondiscriminative clinical characteristics

Answer 21

• Short periods of error-free speech
• Automatic, overlearned speech is better than propositional speech
• Self-corrects and shows other signs of error awareness
• Difficulty initiating speech
• Speech errors increase as word length increases
• Perseverative errors or movements
• Articulatory groping, either visually, audibly, or both

Question 22

Clinical characteristics usually found in other disorders

Answer 22

-A difference between expressive and receptive speech and language abilities.
•Transposition errors on phonemes or syllables
•Anticipatory articulation errors
•Presence of limb or nonverbal oral apraxia (does not indicate a diagnosis or AOS)

Question 23

Clinical characteristics ruling out AOS

Answer 23

• Demonstrates a fast rate of speech
• Has a normal rate of speech
• Normal prosody

Question 24

•Rule out other conditions that cause movement difficulties similar to those seen in apraxia

Answer 24

–Muscle weakness –Sensory loss –Comprehension deficit –Incoordination

Question 25

•Differentiating between apraxia of speech and aphasia

Answer 25

–Three situations present difficulties when making differential diagnosis •Pure apraxia of speech, aphasia alone, or aphasia and apraxia of speech •Apraxia of speech from literal paraphasic errors of aphasia •Apraxia of speech from nonfluent language errors of Broca’s aphasia

Question 26

•Differentiating between apraxia of speech and dysarthria

Answer 26

–Speech errors in apraxia increase as word length and complexity increase; errors of dysarthria fairly constant –Muscle range of motion, tone, coordination, and strength are within normal limits in apraxia of speech; at least one muscle quality impaired in nearly all dysarthrias

Question 27

Additional Diagnostic Considerations

Answer 27

-Apraxia of speech primarily affects articulation and prosody; dysarthria can affect all five –Apraxia of speech can have articulatory groping –Apraxia usually occurs with damage to perisylvian area of language dominant hemisphere; dysarthria can be result of diverse damage –Apraxia of speech co-occurs more frequently with aphasia than dysarthria –Patient with apraxia of speech produce automatic speech and emotional speech with few errors, while those with dysarthria typically demonstrate same errors regardless of whether overlearned or emotional in nature

Question 28

Treatment of Apraxia of Speech

Answer 28

* Mostly behaviorally based procedures to help select and sequence speech sounds correctly * Mostly 1:1 intensive treatments

Question 29

Guiding Principles of Treating Apraxia of Speech

Answer 29

``` Goal: help patient relearn motor sequences to produce phonemes accurately –Not all patients candidates for therapy –Sequenced to maintain success –Repetitive and intensive drill –Patients learn to self-monitor –Concentrate on functional words ```

Question 30

•Articulatory kinematic treatments

Answer 30

–Concentrate on improving timing and placement of articulatory movements through modeling, positioning of articulators, and repetition

Question 31

•Rate and rhythm procedures

Answer 31

–Assume apraxia of speech primarily result of timing errors

Question 32

•Alternative and augmentative communication

Answer 32

–Recommended with limited verbal communication

Question 33

•Intersystemic facilitation and reorganization treatment

Answer 33

–Patient’s communicative strengths used to assist verbal speech

Question 34

Treatment success

Answer 34

* Wambaugh et al. (2006a,b) reviewed all the previous treatment studies, and concluded that individuals with AOS can gain improvement through appropriate therapy. * However, the treatment techniques are specific to each individual.

Question 35

The Eight-Step Continuum Treatment

Answer 35

* Articulatory kinematic procedure developed by Rosebek et al. (1973). * It is an eight-step sequence of structrued activities that moves the patient from repeating target phonemes with the clinician to independent productions of utterances in role-playing situations. * “watch me and listen to me’

Question 36

Sound Production Treatment (SPT)

Answer 36

* Wambaugh and colleagues - Eight-step continuum treatment with articulatory placement cueing, phonetic tasks, and extensive modeling. This is also an articulatory kinematic treatment. * The advantage of this treatment is that it allows to skip treatment steps depending on how well the patient produces the target sounds.

Question 37

SPT hierarchy (modification of the original procedure).

Answer 37

* Step 1 (saying the word) * Step 2 (show the letter) * Step 3 (Watch me and listen to me) * Step 4 (Articulatory placement cueing)

Question 38

Darley, Aronson, and Brown’s procedure

Answer 38

* Another articulatory kinematic procedure * Initial speech activities * Using automatic responses * Phonemic drill

Question 39

Melodic Intonation Therapy

Answer 39

* Rate and rhythm type of apraxia treatment * Elementary level * Intermediate level * Advanced level

Question 40

PROMPT

Answer 40

* Prompts for Restructuring Oral Muscular Targets * Articulatory kinematic treatment * Uses a combination of proprioceptive, pressure, and kinesthetic cues that show patients how to sequence their oral movements for speech. * Basic premise – clinicians tend to acts as external speech programmers. * There are numerous contact points around the mouth, under the chin, and on the neck. * First the clinician says the target production, and then have the patient say. * Correct – next target; incorrect – work on placement

Question 41

Summary

Answer 41

•Apraxia of speech –Disorder of motor sequencing •Not caused by muscle weakness, abnormal muscle tone, reduced range of movement, or decreased muscle steadiness –Subcategory of ideomotor apraxia •Disturbance in performance needed to complete action –Numerous potential causes: stroke most common –Primarily disorder of articulation and prosody •Motor speech programmer –Neural network to control sequencing of speech movement •When diagnosing, important to eliminate condition that cause speech errors similar to those in apraxia of speech •Many treatments available