L4 Apraxia

Question 1

what is apraxia of speech

Answer 1

“ an acquired disorder of learned volitional actions associated with breakdown in the planning or programming of the movements needed for speech” (Miller and Wambaugh, 2017, p. 493).

Question 2

is AOS acquired or developmental

Answer 2

acquired

Question 3

what movements does AOS affect

Answer 3

volitional movements not reflexive movements

Question 4

does it AOS affect non speech movements

Answer 4

no, apraxia of non speech movements are oral apraxia or bucco-facial apraxia

Question 5

who came up with kernal diagnostic features

Answer 5

(McNeil et al., 1997; 2004; 2009)

Question 6

kernal diagnostic features

Answer 6

• Sound distortions (including distorted substitutions)
• Extended segment durations - segment meaning sound or syllable
• Extended intersegment durations - long pauses give a robotic quality
• Prosodic deficits - monotone, no intonation or melody, aids in robotic effect

Question 7

segment

Answer 7

smallest unit of sound e.g. a consonant or syllable

Question 8

substitutions

Answer 8

speaker has selected or accessed incorrect phonemes and articulated these normally (e.g in phonemic paraphasia)

Question 9

distortions

Answer 9

the correct phoneme was accessed, but articulated in an imprecise or unusual way (e.g. in AOS, dysarthria)

Question 10

distorted substitutions

Answer 10

the impression that both phoneme selection and articulatory accuracy are incorrect – most common error type in AOS

Question 11

most common distortions in AOS

Answer 11

length, voicing, tongue placement

Question 12

extended segment durations

Answer 12

lengthened production of consonants and vowels → rate of speech is perceived as slower overall

Question 13

Extended intersegment durations

Answer 13

lengthened pauses between sounds and between words → speech sounds segmented

Question 14

what is an intrusive schwa

Answer 14

the insertion of a shwa into a segment where there shouldn’t be one

Question 15

prosodic deficits that occur in AOS

Answer 15

• restricted alteration of pitch, intonation, loudness – may sound monotonous
• Slow rate of speech is common – this may be due to increased segment and intersegment durations
• Equal lexical stress
• No longer sound like themselves/unnatural sounding
• Can very occasionally sound like a foreign accent

Question 16

non-discriminatory features of AOS

Answer 16

• articulatory groping
• perserverative errors
• increasing errors with word length
• awareness of errors
• variability

Question 17

what is articulatory groping

Answer 17

• Gives the impression that speaker is trying to find right position
• Can be silent or auditory

Question 18

error location

Answer 18

whether an error occurs on the same target sound within a word across repeated trials

Question 19

error type

Answer 19

whether the same error is made within the same location of a word across repeated trials

Question 20

what is not a feature of AOS

Answer 20

discriminatory errors - may find this in old literature but no longer considered true

Question 21

severity scale of AOS

Answer 21

Slightly slow, relatively fluent speech → slow segmented speech with lots of sounds errors and disturbed prosody → complete inability to speak

Question 22

what happens if there is minimal or no speech output

Answer 22

It is difficult to reliably diagnose AOS in a client who has very little speech output, because this does not allow you to observe the core features of AOS. You might reach a tentative diagnosis of “probable” or “suspected” AOS but you may also need to consider other diagnoses such as aphasia. Being unable to produce any verbal output can also be caused by aphasia.

Question 23

AOS and aphasia

Answer 23

co-occur very often

Question 24

AOS and dysarthria

Answer 24

sometimes co-occur

Question 25

pure AOS

Answer 25

very rare

Question 26

Acute AOS

Answer 26

- Primarily caused by stroke – typically left hemisphere; most often frontal and parietal lobes; most often larger strokes - Can also be caused by head injury (traumatic brain injury or TBI) or a brain tumour/brain surgery

Question 27

when can AOS be caused by a right hemisphere stroke

Answer 27

when the person is left handed (dominant hemispheres switched)

Question 28

when does primary progressive AOS (Josephs et al., 2006) occur

Answer 28

as the first sign of a progressive neuro-degenerative disease

Question 29

what diseases can primary progressive AOS be a sign of

Answer 29

- Cortico-basilar degeneration (CBD) - Progressive supranuclear palsy (PSP) - Motor neurone disease(MND)/Amyotrophic lateral sclerosis (ALS)

Question 30

which brain regions have been proposed as being assocaiated with AOS

Answer 30

- left insula - Broca’s area/left inferior frontal gyrus - Pre-central gyrus - primary motor area - Post-central gyrus - primary somtosensory area - Pre motor cortex

Question 31

why is it hard to definitively say where AOS lesions occur

Answer 31

- speech is organised all over the brain - stroke/TBI can damage more than one area of the brain - organisation of the brain may change after injury due to neuroplacticity

Question 32

what is a motor plan

Answer 32

- Brain tells articulators where to move, when to move and in what way to move - Brain also tells articulators how fast to move, for how long and with how much force

Question 33

four stages of van der merwe's model of motor planning

Answer 33

1. conceptual-linguistic stage 2. motor planning stage 3. motor programming 4. execution

Question 34

conceptual linguistic phase (van der merwe 1997)

Answer 34

- Pre-motor stage - Intention to speak - Message is constructed - syntax, semantics, morphology - Phonological plan (phonemes)

Question 35

motor planning stage (van der merwe 1997)

Answer 35

- Strategy of action - Spatial specifications (place and manner of articulation) - Temporal specifications (timing) - Core motor plans are goals of movement

Question 36

motor programming stage (van der merwe 1997)

Answer 36

- Muscle-specific programs selected and sequenced - Spatial and temporal dimensions; tone direction, force and rate

Question 37

execution stage (van der merwe 1997)

Answer 37

Articulators carry out the motor plan to form speech

Question 38

which of the stages of van der merwe's model of motor planning (1997) is affected by aphasia

Answer 38

conceptual linguistic

Question 39

which of the stages of van der merwe's model of motor planning (1997) is affected by AOS

Answer 39

motor planning

Question 40

which of the stages of van der merwe's model of motor planning (1997) is affected by dysarthria

Answer 40

execution

Question 41

what does DIVA stand for | models of motor planning

Answer 41

Directions Into Velocities of Articulator

Question 42

Explain DIVA model of motor planning

Answer 42

- This model suggests that we have a “speech sound map” believed to be located in the left frontal cortex - This “map” area is believed to be made up of “mirror neurons” (Hickock, 2012) which are activated both when a sound is produced and heard - These neurons are thought to be responsible for motor planning/programming by sending out “feedforward” commands to the articulators, and receiving “feedback” from auditory and sensory routes

Question 43

theories to explain what goes wrong with motor planning in AOS (Miller and Wambaigh, 2017)

Answer 43

- The brain selects the incorrect motor programme (i.e. the opening or closing settings or sequences for the articulators) for the intended production target - (e.g. selects the programme for /p/ when the target was /d/) - The brain can no longer access stored programmes for the intended target, or the quality of these stored programmes has deteriorated - There is interference in the brain between competing motor programmes - (e.g., competition between the tongue tip and the dorsum raising in target /’take’/ → → may lead to what the listener hears as /‘cake’/ - The correct programme is selected, but the programme is applied to the wrong articulator - (e.g., closing gesture applied to tongue dorsum instead of lips for the target /m/ would result in production of /ng/ instead)

Question 44

explain feedforward and feedback in motor planning (ballard, tourville and robin, 2014)

Answer 44

1. A movement goal is identified (e.g. producing a syllable) 2. A motor program or command for that movement is activated and initiated 3. Simultaneously an efference copy of that command is generated, i.e. a prediction of the expected sensory feedback from the issued motor command 4. As the movement unfolds, the actual sensory consequences are compared to the prediction 5. If a mismatch is detected, error signals arise and corrective motor commands are generated to modify the ongoing movement 6. The error signals are also used to update the “stored” motor programs, thereby improving the accuracy of future attempts to perform that motor task → this is motor learning