8.1 - Apraxia of Speech Flashcards
What is Praxis?
The volitional performance of skilled movements
What does Volitional mean?
Purposeful (not automatic)
What does Skilled mean?
Previously learned or practiced
What is Ideomotor Apraxia?
2
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.
What is Ideational Apraxia?
3
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.
What is Conceptual Apraxia?
Impairment of object or action knowledge.
What is the most common Apraxia: Ideomotor, Ideational, or Conceptual?
Ideomotor
How is the Frontal Lobe involved in intentional movement?
Will to act
How is the Supplementary Motor Area involved in intentional movement?
Initiates + guides volitional movement
How is the Premotor Cortex involved in intentional movement?
3
Learns motor movement
Selects motor movement
Adjusts motor programs
How is the Primary Motor Cortex involved in intentional movement?
Executes movement
How is the Parietal Lobe involved in intentional movement?
Spatial-temporal movements
What is the Motor Speech Programmer’s job?
2
Establishes plans and programs for spoken messages
Organizes motor commands that result in production of
temporally ordered sounds, syllables, words, etc
What will damage to perisylvian language zone result in?
Co-occurrence
of language related deficits and AOS
What are the 6 Key Components of the Motor Speech Programmer?
Broca’sArea
Supplementary Motor Area
Pre-Motor Area
Parietal Lobe
Supramarginal Gyrus
Insula Cortex
What are 7 cortical areas influence the Motor Speech Programmer?
Sensory feedback
Basal ganglia
Cerebellar control circuits
Reticular formation
Thalamus
Limbic system
Right hemisphere
Is Apraxia typically co-occur with Wernicke’s Aphasia?
No. Apraxia comes from anterior damage
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 _______________.
Plan or program
Physiologic disturbances
Language
What is Apraxia of Speech (AOS)?
3
Articulatory - prosodic motor speech disorder
May present in pure form (spared language)
Usually co-exists with nonfluent (Broca’s type) aphasia
Is Apraxia of Speech (AOS) Aphasia?
No
Is Apraxia of Speech (AOS) Dysarthria?
No
Is Apraxia of Speech (AOS) Oral Apraxia?
No
What is Motor Planning?
3
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
What is Motor Programming?
2
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)
What is Motor Execution?
2
Plans and programs are transformed into actual
movements
Realization of speech at articulatory level
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
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
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
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
What 4 things should we watch out for in Apraxia of Speech (AOS)?
Temporal-spatial errors
Retrials, variability
Vowel + consonant distortions
Slowness, dysprosody
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
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
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”
What do Patient Complaints tend to center on in Apraxia of Speech (AOS)?
(5)
Articulation
Rate
Breathing (rarely)
Phonation (rarely)
Resonance (rarely)
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
Dysarthria is a problem of speech sound production / execution resulting from: abnormal _______, _______, _______, and/or _______.
Tone
Posture
Strength
Coordination
Traditionally, planning and programming disorders (Apraxia) are not consistent with disorders of _______ or _______.
Tone
Reflexes
According to Ogar et al. (2006)’s study, where did MILDLY Apraxic patients tend to have lesions?
(2)
Insula
Immediately surrounding areas.
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
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)
According to Ogar et al. (2006)’s study, where did patients with NO Apraxia tend to have lesions?
More posteriorly
Chronic AOS strongly associated with __________.
Larger infarcts
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
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
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
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
___________ was not associated with chronic AOS after controlling for lesion volume.
Anterior insula
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
What is a standard assessment we can use to test of AOS?
Is this usually needed clinically?
Apraxia Battery for Adults
No
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
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
What is a rating scale we can use for AOS?
Apraxia of Speech Rating Scale
And it’s free!
Is there such a thing as Primary Progressive AOS?
Yes
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.
What four areas do we test for Oral Apraxia?
Respiration
Phonation
Resonance
Oral-Nonspeech-Articulatory
How do we test Respiration for Oral Apraxia?
4
Sigh
Volitional inhalation
Volitional exhalation
Blow
How do we test Phonation for Oral Apraxia?
3
Clear throat
Cough
Vocalize (on, off, sustain)
How do we test Resonance for Oral Apraxia?
4
/a/
/m/
/m…a:…p/
Nonspeech airflow: (Sniff in, Sniff out, Snort)
How do we test Oral-Nonspeech-Articulatory for Oral Apraxia?
6
Pucker
Puff cheeks
Show teeth
Protrude tongue
Kiss
Lick lips
Is Ideomotor Limb Apraxia the most frequent type of apraxia?
Yes
Does Ideomotor Limb Apraxia occur in a variety of manifestations?
Yes
Do those with Ideomotor Limb Apraxia respond poorly to movement commands?
Yes
Does Ideomotor Limb Apraxia usually improve with a model?
Yes
Can those with Ideomotor Limb Apraxia use objects appropriately?
No
What happens with object use in Ideational Apraxia?
3
Ideational plan disordered; loss of goal
Poor to command bilaterally
Cannot use objects
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)
What may account for rarity of ideational apraxia?
Biparietal representation for use of actual objects
What should we watch for in Ideational Limb Apraxia?
4
Temporal-spatial errors
Spontaneous > volitional
Affects both arms/hands
“Body-part-as-object”
What Temporal-Spatial Errors should we watch for in Ideational Limb Apraxia?
(4)
Spatial misalignment
Poor timing (delays, transitions)
Groping, off-target
Lacking smoothness
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
What are 5 other types of Apraxia?
Trunkal
Gait
Constructional (drawing, blocks)
Dressing
Ocular
