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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
Q

What is Motor Execution?

2

A

Plans and programs are transformed into actual
movements

Realization of speech at articulatory level

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26
Q

What are the highlights of how Dabul (2000) saw Apraxia of Speech (AOS)?

(4)

A

Visible + audible searching behaviors

Highly inconsistent errors

Fewer errors in automatic speech than volitional

Marked difficulty initiating speech

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27
Q

What are the highlights of how Wertz et al (1984) saw Apraxia of Speech (AOS)?

(4)

A

Effortful trial, groping articulatory
movements

Dysprosody

Articulatory inconsistency on repeated productions of the same utterance

Obvious difficulty initiating utterances

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28
Q

What are the 4 KEY Characteristics of Apraxia of Speech (AOS)?

(4)

A

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

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29
Q

What are all the Characteristics of Apraxia of Speech (AOS)?

6

A

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
Q

What 4 things should we watch out for in Apraxia of Speech (AOS)?

A

Temporal-spatial errors

Retrials, variability

Vowel + consonant distortions

Slowness, dysprosody

31
Q

What 4 Temporal-Spatial Errors should we look out for in Apraxia of Speech (AOS)?

A

Spatial misalignment

Poor timing (delays, transitions)

Groping, off-target

Lacking smoothness

32
Q

What is seen in Severe Apraxia of Speech (AOS)?

4

A

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
Q

What do Patients often Complain about in Apraxia of Speech (AOS)?

(4)

A

“My speech won’t come out the right way”

“Not as fluent as before”

“Mispronounce words”

“Stutter”

34
Q

What do Patient Complaints tend to center on in Apraxia of Speech (AOS)?

(5)

A

Articulation

Rate

Breathing (rarely)

Phonation (rarely)

Resonance (rarely)

35
Q

AOS is a problem programming the selection, sequencing and timing of speech sounds resulting from difficulty ___________ of a given speech act.

A

Constructing the spatial temporal goals

36
Q

Dysarthria is a problem of speech sound production / execution resulting from: abnormal _______, _______, _______, and/or _______.

A

Tone

Posture

Strength

Coordination

37
Q

Traditionally, planning and programming disorders (Apraxia) are not consistent with disorders of _______ or _______.

A

Tone

Reflexes

38
Q

According to Ogar et al. (2006)’s study, where did MILDLY Apraxic patients tend to have lesions?

(2)

A

Insula

Immediately surrounding areas.

39
Q

According to Ogar et al. (2006)’s study, where did MODERATELY Apraxic patients tend to have lesions?

(6)

A

Superior precentral gyrus

Middle frontal gyrus

Broca’s area

Basal ganglia

External capsule

Internal capsule

40
Q

According to Ogar et al. (2006)’s study, where did SEVERELY Apraxic patients tend to have lesions?

(8)

A

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
Q

According to Ogar et al. (2006)’s study, where did patients with NO Apraxia tend to have lesions?

A

More posteriorly

42
Q

Chronic AOS strongly associated with __________.

A

Larger infarcts

43
Q

Patients who fail to recover from AOS tend to have large infarcts involving
most of the territory supplied by the __________.

A

Superior division of the left MCA

44
Q

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.

A

Left frontal and anterior temporal cortex

45
Q

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 _______.

A

Recover

46
Q

If all of the territory in the left frontal and anterior temporal cortex in the MCA territory is damaged, the network may __________.

A

Not be able to recover

47
Q

___________ was not associated with chronic AOS after controlling for lesion volume.

A

Anterior insula

48
Q

What 6 tasks can we use to test of AOS?

A

SMR’s

Counting – forward + backward

Vowels + consonants

Words of increasing length

Repeated trials

Spontaneous speech

49
Q

What is a standard assessment we can use to test of AOS?

Is this usually needed clinically?

A

Apraxia Battery for Adults

No

50
Q

Why was the Apraxia Battery for Adults developed?

What can the scores describe?

A

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
Q

What are the 6 subtests in the Apraxia Battery for Adults?

A

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
Q

What is a rating scale we can use for AOS?

A

Apraxia of Speech Rating Scale

And it’s free!

53
Q

Is there such a thing as Primary Progressive AOS?

A

Yes

54
Q

What is Oral Apraxia?

A

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
Q

What four areas do we test for Oral Apraxia?

A

Respiration

Phonation

Resonance

Oral-Nonspeech-Articulatory

56
Q

How do we test Respiration for Oral Apraxia?

4

A

Sigh

Volitional inhalation

Volitional exhalation

Blow

57
Q

How do we test Phonation for Oral Apraxia?

3

A

Clear throat

Cough

Vocalize (on, off, sustain)

58
Q

How do we test Resonance for Oral Apraxia?

4

A

/a/

/m/

/m…a:…p/

Nonspeech airflow: (Sniff in, Sniff out, Snort)

59
Q

How do we test Oral-Nonspeech-Articulatory for Oral Apraxia?

6

A

Pucker

Puff cheeks

Show teeth

Protrude tongue

Kiss

Lick lips

60
Q

Is Ideomotor Limb Apraxia the most frequent type of apraxia?

A

Yes

61
Q

Does Ideomotor Limb Apraxia occur in a variety of manifestations?

A

Yes

62
Q

Do those with Ideomotor Limb Apraxia respond poorly to movement commands?

A

Yes

63
Q

Does Ideomotor Limb Apraxia usually improve with a model?

A

Yes

64
Q

Can those with Ideomotor Limb Apraxia use objects appropriately?

A

No

65
Q

What happens with object use in Ideational Apraxia?

3

A

Ideational plan disordered; loss of goal

Poor to command bilaterally

Cannot use objects

66
Q

What happens when those with Ideational Apraxia try to use objects?

(2)

A

Correct gesture, wrong object (e.g., toothbrush for eating)

Correct object, incorrect gesture (e.g., microphone to ear)

67
Q

What may account for rarity of ideational apraxia?

A

Biparietal representation for use of actual objects

68
Q

What should we watch for in Ideational Limb Apraxia?

4

A

Temporal-spatial errors

Spontaneous > volitional

Affects both arms/hands

“Body-part-as-object”

69
Q

What Temporal-Spatial Errors should we watch for in Ideational Limb Apraxia?

(4)

A

Spatial misalignment

Poor timing (delays, transitions)

Groping, off-target

Lacking smoothness

70
Q

What 9 tasks can we use to sample Ideational Limb Apraxia?

A

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
Q

What are 5 other types of Apraxia?

A

Trunkal

Gait

Constructional (drawing, blocks)

Dressing

Ocular

ECU Motor Speech Disorders (16 decks)

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