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ECU Motor Speech Disorders > 8.1 - Apraxia of Speech > Flashcards

8.1 - Apraxia of Speech Flashcards

1
Q

What is Praxis?

A

The volitional performance of skilled movements

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2
Q

What does Volitional mean?

A

Purposeful (not automatic)

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3
Q

What does Skilled mean?

A

Previously learned or practiced

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4
Q

What is Ideomotor Apraxia?

2

A

Impaired performance of skilled motor acts despite intact sensory, motor,
and language function.

Typically demonstrated when a patient is asked verbally to perform a gesture with a limb.

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5
Q

What is Ideational Apraxia?

3

A 
Difficulty carrying out a sequence of actions in performance of a complex,
multistep task (eg, making a cup of tea).

Seen in patients with extensive left hemisphere damage, dementia, or delirium.

Deficits due to combination of executive, language, and memory limitations or generally limited cognitive resources.

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6
Q

What is Conceptual Apraxia?

A

Impairment of object or action knowledge.

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7
Q

What is the most common Apraxia: Ideomotor, Ideational, or Conceptual?

A

Ideomotor

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8
Q

How is the Frontal Lobe involved in intentional movement?

A

Will to act

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9
Q

How is the Supplementary Motor Area involved in intentional movement?

A

Initiates + guides volitional movement

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10
Q

How is the Premotor Cortex involved in intentional movement?

3

A

Learns motor movement

Selects motor movement

Adjusts motor programs

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11
Q

How is the Primary Motor Cortex involved in intentional movement?

A

Executes movement

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12
Q

How is the Parietal Lobe involved in intentional movement?

A

Spatial-temporal movements

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13
Q

What is the Motor Speech Programmer’s job?

2

A

Establishes plans and programs for spoken messages

Organizes motor commands that result in production of
temporally ordered sounds, syllables, words, etc

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14
Q

What will damage to perisylvian language zone result in?

A

Co-occurrence

of language related deficits and AOS

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15
Q

What are the 6 Key Components of the Motor Speech Programmer?

A

Broca’sArea

Supplementary Motor Area

Pre-Motor Area

Parietal Lobe

Supramarginal Gyrus

Insula Cortex

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16
Q

What are 7 cortical areas influence the Motor Speech Programmer?

A

Sensory feedback

Basal ganglia

Cerebellar control circuits

Reticular formation

Thalamus

Limbic system

Right hemisphere

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17
Q

Is Apraxia typically co-occur with Wernicke’s Aphasia?

A

No. Apraxia comes from anterior damage

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18
Q

Apraxia of Speech (AOS) is a neurologic speech disorder that reflects an impaired capacity to _____________ sensorimotor commands necessary for directing movements that result in phonetically and prosodically normal speech. It can occur in the absence of ______________ associated with the dysarthrias and in
the absence of disturbance in any component of _______________.

A

Plan or program

Physiologic disturbances

Language

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19
Q

What is Apraxia of Speech (AOS)?

3

A

Articulatory - prosodic motor speech disorder

May present in pure form (spared language)

Usually co-exists with nonfluent (Broca’s type) aphasia

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20
Q

Is Apraxia of Speech (AOS) Aphasia?

A

No

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21
Q

Is Apraxia of Speech (AOS) Dysarthria?

A

No

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22
Q

Is Apraxia of Speech (AOS) Oral Apraxia?

A

No

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23
Q

What is Motor Planning?

3

A

Formulation of strategy of action by defining motor goals

Motor goals are found in spatial (place and manner of artic) and temporal (timing) specifications of movements

Motor goals for each speech sound are identified + arranged to occur concurrently and sequentially

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24
Q

What is Motor Programming?

2

A

Selection and sequencing of motor programs for the
movements of the individual muscles of articulation

Spatial-temporal and force dimensions are specified (tone, movement, velocity, force, range & stiffness of joints)

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25
What is Motor Execution? | 2
Plans and programs are transformed into actual movements Realization of speech at articulatory level
26
What are the highlights of how Dabul (2000) saw Apraxia of Speech (AOS)? (4)
Visible + audible searching behaviors Highly inconsistent errors Fewer errors in automatic speech than volitional Marked difficulty initiating speech
27
What are the highlights of how Wertz et al (1984) saw Apraxia of Speech (AOS)? (4)
Effortful trial, groping articulatory movements Dysprosody Articulatory inconsistency on repeated productions of the same utterance Obvious difficulty initiating utterances
28
What are the 4 KEY Characteristics of Apraxia of Speech (AOS)? (4)
SOUND SUBSTITUTIONS predominate, including additive substitutions INITIATION DIFFICULTY (stops + restarts), sound, syllable and whole-word repetition VARIABILITY of error pattern on repeated trials of the same word ISLANDS OF ERROR-FREE PRODUCTION
29
What are all the Characteristics of Apraxia of Speech (AOS)? | 6
More consonant than vowel errors More substitutions than distortions, omission, or addition errors More errors in word initial than word final position More errors of simplification (consonant cluster reduction) than complication More single-feature than multiple-feature sound substitutions More place than manner or voicing errors
30
What 4 things should we watch out for in Apraxia of Speech (AOS)?
Temporal-spatial errors Retrials, variability Vowel + consonant distortions Slowness, dysprosody
31
What 4 Temporal-Spatial Errors should we look out for in Apraxia of Speech (AOS)?
Spatial misalignment Poor timing (delays, transitions) Groping, off-target Lacking smoothness
32
What is seen in Severe Apraxia of Speech (AOS)? | 4
Limited repetoire of sounds Isolated sounds may be in error No significant differences between automatic and volitional speech (can't do rout speech tasks) Usually accompanied by severe aphasia (expressive) due to larger area of cortical damage
33
What do Patients often Complain about in Apraxia of Speech (AOS)? (4)
“My speech won’t come out the right way” “Not as fluent as before” “Mispronounce words” “Stutter”
34
What do Patient Complaints tend to center on in Apraxia of Speech (AOS)? (5)
Articulation Rate Breathing (rarely) Phonation (rarely) Resonance (rarely)
35
AOS is a problem programming the selection, sequencing and timing of speech sounds resulting from difficulty ___________ of a given speech act.
Constructing the spatial temporal goals
36
Dysarthria is a problem of speech sound production / execution resulting from: abnormal _______, _______, _______, and/or _______.
Tone Posture Strength Coordination
37
Traditionally, planning and programming disorders (Apraxia) are not consistent with disorders of _______ or _______.
Tone Reflexes
38
According to Ogar et al. (2006)'s study, where did MILDLY Apraxic patients tend to have lesions? (2)
Insula Immediately surrounding areas.
39
According to Ogar et al. (2006)'s study, where did MODERATELY Apraxic patients tend to have lesions? (6)
Superior precentral gyrus Middle frontal gyrus Broca’s area Basal ganglia External capsule Internal capsule
40
According to Ogar et al. (2006)'s study, where did SEVERELY Apraxic patients tend to have lesions? (8)
Superior precentral gyrus Middle frontal gyrus Broca’s area Basal ganglia External capsule Internal capsule. Fibers of the superior longitudinal fasciculus (SLF). Primary auditory cortex (in some patients)
41
According to Ogar et al. (2006)'s study, where did patients with NO Apraxia tend to have lesions?
More posteriorly
42
Chronic AOS strongly associated with __________.
Larger infarcts
43
Patients who fail to recover from AOS tend to have large infarcts involving most of the territory supplied by the __________.
Superior division of the left MCA
44
Findings suggest many areas of the ___________ in the MCA territory are capable of assuming the role of the damaged components of the network underlying speech articulation for those with AOS.
Left frontal and anterior temporal cortex
45
If any of the associated areas in the left frontal and anterior temporal cortex in the MCA territory are left intact, the network will be able to _______.
Recover
46
If all of the territory in the left frontal and anterior temporal cortex in the MCA territory is damaged, the network may __________.
Not be able to recover
47
___________ was not associated with chronic AOS after controlling for lesion volume.
Anterior insula
48
What 6 tasks can we use to test of AOS?
SMR’s Counting – forward + backward Vowels + consonants Words of increasing length Repeated trials Spontaneous speech
49
What is a standard assessment we can use to test of AOS? Is this usually needed clinically?
Apraxia Battery for Adults No
50
Why was the Apraxia Battery for Adults developed? What can the scores describe?
To verify the presence of apraxia in adults and to estimate the severity of the disorder Patient performance overtime and quantify the diagnosis and severity
51
What are the 6 subtests in the Apraxia Battery for Adults?
Diadochokinetic rates – 1, 2 3 syllables Imitation of words – Increasing length Latency + utterance time for picture naming –multisyllabic words Repetition of polysyllabic words Inventory of 15 based on spontaneous speech, reading, counting Limb + oral apraxia test
52
What is a rating scale we can use for AOS?
Apraxia of Speech Rating Scale | And it's free!
53
Is there such a thing as Primary Progressive AOS?
Yes
54
What is Oral Apraxia?
Inability to imitate or follow commands to perform volitional movements of speech structures (e.g., cough, blow, click the tongue) that cannot be attributed to poor task comprehension or sensory or neuromuscular deficits.
55
What four areas do we test for Oral Apraxia?
Respiration Phonation Resonance Oral-Nonspeech-Articulatory
56
How do we test Respiration for Oral Apraxia? | 4
Sigh Volitional inhalation Volitional exhalation Blow
57
How do we test Phonation for Oral Apraxia? | 3
Clear throat Cough Vocalize (on, off, sustain)
58
How do we test Resonance for Oral Apraxia? | 4
/a/ /m/ /m...a:...p/ Nonspeech airflow: (Sniff in, Sniff out, Snort)
59
How do we test Oral-Nonspeech-Articulatory for Oral Apraxia? | 6
Pucker Puff cheeks Show teeth Protrude tongue Kiss Lick lips
60
Is Ideomotor Limb Apraxia the most frequent type of apraxia?
Yes
61
Does Ideomotor Limb Apraxia occur in a variety of manifestations?
Yes
62
Do those with Ideomotor Limb Apraxia respond poorly to movement commands?
Yes
63
Does Ideomotor Limb Apraxia usually improve with a model?
Yes
64
Can those with Ideomotor Limb Apraxia use objects appropriately?
No
65
What happens with object use in Ideational Apraxia? | 3
Ideational plan disordered; loss of goal Poor to command bilaterally Cannot use objects
66
What happens when those with Ideational Apraxia try to use objects? (2)
Correct gesture, wrong object (e.g., toothbrush for eating) Correct object, incorrect gesture (e.g., microphone to ear)
67
What may account for rarity of ideational apraxia?
Biparietal representation for use of actual objects
68
What should we watch for in Ideational Limb Apraxia? | 4
Temporal-spatial errors Spontaneous > volitional Affects both arms/hands “Body-part-as-object”
69
What Temporal-Spatial Errors should we watch for in Ideational Limb Apraxia? (4)
Spatial misalignment Poor timing (delays, transitions) Groping, off-target Lacking smoothness
70
What 9 tasks can we use to sample Ideational Limb Apraxia?
Make a fist Wave goodbye Show me “come here” Show me “okay” Snap your fingers Show me throwing the ball Show me locking with a key Show me eating with a fork Show me writing with a pen
71
What are 5 other types of Apraxia?
Trunkal Gait Constructional (drawing, blocks) Dressing Ocular

ECU Motor Speech Disorders (16 decks)

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