8b. Neurologically Based Communication Disorders and Dysphagia -- APRAXIA of SPEECH

Question 1

AOS: Definition and Distinctions

Answer 1

• AOS is a neurogenic speech disorder characterized by sensorimotor probs in positioning and sequentially moving muscles for the volitional production of speech
• Apraxia is a basic disorder of volitional movement in the absence of muscle weakness, paralysis, or fatigue; AOS is a special case of apraxia
• Caused by damage/injury to speech-motor programming areas (Broca’s and supplementary motor areas) in dom. hemisphere
• AOS more frequently coexists with aphasia, esp. Broca’s, and less frequently with dysarthria and unilateral UMN type; Pure AOS is rare; Language skills are only affected when there is a coexisting aphasia
• Many comm. probs, esp. those caused by oral groping to produce speech sounds and struggling to speak
• May be associated w/ prosodic problems
• AOS is frequently associated w/ nonverbal oral apraxia
• Dx/Tx: detailed procedures related to evaluating and improving artic. accuracy, speech rate, and self-monitoring

Question 2

AOS: Definition and Distinctions

Answer 2

• AOS is a neurogenic speech disorder characterized by sensorimotor probs in positioning and sequentially moving muscles for the volitional production of speech
• Apraxia is a basic disorder of volitional movement in the absence of muscle weakness, paralysis, or fatigue; AOS is a special case of apraxia
• Caused by damage/injury to speech-motor programming areas (e.g., Broca’s) in dom. hemisphere
• AOS more frequently coexists with aphasia, esp. Broca’s, and less frequently with dysarthria and unilateral UMN type; Pure AOS is rare; Language skills are only affected when there is a coexisting aphasia
• Many comm. probs, esp. those caused by oral groping to produce speech sounds and struggling to speak
• May be associated w/ prosodic problems
• AOS is frequently associated w/ nonverbal oral apraxia
• Dx/Tx: detailed procedures related to evaluating andimproving artic. accuracy, speech rate, and self-monitoring

Question 3

Communication Deficits in AOS

Answer 3

• May have independent prob of aud. processing probs
• Most pts have gen. awareness of their speech probs
• Pts’ initiation of speech may be slowed/delayed
• Pts may use a compensatory strategy of reduced rate
• *Dominant symptoms: speech programming and production errors (with relatively unaffected automatic speech)
• *Highly variable speech errors, significant articulatory probs, increased frequency of errors on long words, prosodic probs, groping and struggling behaviors
• Pts frequently have prosodic problems (e.g., rate, pauses, impaired intonation b/c increased duration of C s and Vs, even syllable stress, restricted range of loudness, limited pitch range, fluency probs such as pauses and repetitions)

Question 4

Assessment of AOS

Answer 4

Involves the following:

• Tape-recording of speech samples and transcribing the responses phonetically; taking note of struggle and groping, self-correction, repetition, etc
• Imitative production of speech sound
• Repetitive production of syllables (e.g., puh-puh-puh) and multiple syllables (e.g., puh-tuh-kuh+repeat)
• Imitative production of progressively longer words
• Repeated, imitative production of words and phrases
• Imitative production of sentences
• Counting responses
• Picture descriptions
• Oral reading
• Diadochokinetic test to assess oral, nonverbal movement, oral apraxia, or coexisting dysarthria in case of significant muscle weakness or paralysis
• Limb movements to eval. limb apraxia
• Administration of standardized tests (e.g., ABA)

Question 5

Treatment of AOS

Answer 5

• Automatic speech to less automatic to spontaneous
• Simpler productions precedes complex
• Mostly focus on speech vs nonspeech movements
• Practice w/ variety of sounds and sound combinations
• Targets: artic. accuracy, slower rate, practice, prosody
• Gradual increase of rate and teaching self-monitoring
• Instructions, demonstration, modeling, shaping, phonetic placement, frequent cueing, use of rhythm, immediate positive or corrective feedback
• Contrastive stress tasks, phonetic contrasts, carrier phrases, and singing may be useful
• Emphasis on total comm. for some clients
• In cases of sever AOS, fam/health-care workers should be asked to speak slowly, reduce b/g noise, talk only when ct is focused, and use total communication