AOS

Question 1

Apraxia of Speech (Acquired Type)

Answer 1

Motor speech d/o “resulting from impairment, as a result of brain damage, of the capacity to program the position of speech musculature & the sequencing of muscle movements for the volitional production of phonemes
No significant weakness, slowness, or incoordination in reflex or automatic acts
Prosodic alterations may be associated w/ artic problem, perhaps in attempt to compensate

Question 2

AOS Overview of Problem

Answer 2

Neurological deficit in production of speech sounds
Occurs in absence of muscle weakness, abnormal muscle tone, reduced ROM, or decreased muscle steadiness
Deficiency in ability to accurately sequence movements needed to produce speech sounds
Prob should be referenced as dyspraxia as there is d/o’ed action not lack of movement

Question 3

AOS types

Answer 3

2 primary (main) types of apraxia:

1: ideational apraxia
2: ideomotor apraxia

Question 4

Ideational Apraxia

Answer 4

Inability to make use of object or gesture b/c individual has lost knowledge (or idea) of object’s/gesture’s function
Disturbance in conception of object/gesture
Uncommon d/o that typically results from damage to left parietal lobe
Often goes undetected; masked by other d/o’s (aphasia, etc.)
Difficult to detect as it resolves quickly when caused by a stroke

Question 5

Ideomotor Apraxia

Answer 5

Disturbance in the performance of movements needed to use an object, make a gesture, or complete sequence of individual movements
AOS is 1
Typically affects voluntary movements moreso than automatic movements
At least 3 subcategories

Question 6

3 Subcategories of Ideomotor Apraxia

Answer 6

Limb Apraxia
Nonverbal Oral Apraxia
AOS

Question 7

Limb Apraxia

Answer 7

Inability to sequence movements of the arms, legs, hands, or feet during a volitional action
Often from left hemisphere damage
Affects both the left/right limbs, although hemiplegia might hide its effects on 1 side of the body

Question 8

Nonverbal Oral Apraxia Other Names

Answer 8

Oral apraxia, buccofacial apraxia, facial apraxia, lingual apraxia

Question 9

Nonverbal Oral Apraxia

Answer 9

Deficit in ability to sequence nonverbal voluntary movements of tongue, lips, jaw, & other associated oral structures
Individuals will grope for correct position, delay performing action, add extra unnecessary movements
Commonly seen in those suffering left hemisphere damage; can co-occur w/ aphasia, AOS or verbal apraxia of speech

Question 10

What is AOS and where is the damage?

Answer 10

Deficit in ability to sequence motor commands needed to correctly position articulators during voluntary production of phonemes; usually caused by damage to left frontal lobe (esp. when damage occurs near Broca’s)
Duffy suggests it can co-occur w/ UUMN dysarthria

Question 11

Etiologies of AOS

Answer 11

Typically result of injury to the perisylvian area of left hemisphere; injuries to insula & basal ganglia have also been known to cause it
Specific etiologies: Most common is CVA (58%)
Degenerative disease: Alzheimers, PPA, Creutzfeldt-Jakob disease (16%)
Trauma (15%), esp. surgical trauma
(11%) tumor related

Question 12

General Speech Characteristics of AOS

Answer 12

Primarily a d/o of artic & prosody

Other subsystems may be impacted as well

Question 13

AOS Artic

Answer 13

Substitutions of 1 phoneme for another are more common (may be distortions of target phoneme tho)
Placement errors are most frequent type of sub error then manner, voicing, & oral-nasal errors
Substitution of voiceless phoneme for voiced phoneme more common
Fricatives & affricates more often in error than stops, nasals, semivowels, vowels
Clusters more likely to be in error
Initial position deficits more likely than medial or final
More accuracy on real words than nonsense
Errors more common on multisyllabic words
Greater the distance b/t articulatory contacts the higher the rt. of breakdown: “puh, puh, puh” vs. “puh, tuh, kuh”; think about AMRs vs. SMRs
Errors will be inconsistent during repeated utterances of same word

Question 14

AOS Prosody

Answer 14

Rate of connected speech slower than normal
Equal stress often placed on all syllables in an utterance
Silent pauses may occur at initiation of word or between syllables (maybe result of artic groping)
Normal variations in pitch & loudness in utterances may be reduced

Question 15

AOS Respiration

Answer 15

Some individuals may not be able to take a deep breath when asked to do so on command
Will demonstrate halting, effortful movements
This is voluntary; reflexive respiration is not affected

Question 16

AOS Phonation

Answer 16

Usually not impacted when AOS is mild/mod
Suspected difficulties really related to artic issue where pt is struggling for correct articulator placement
In severe AOS, Pt may be unable to prolong a vowel for both spontaneous & voluntary tasks; Duffy suggests this occurs usu. in 1st 1-2 wks following onset of apraxia

Question 17

Differential Diagnosis: Aphasia or Apraxia:

Answer 17

Does pt have pure AOS? AOS & aphasia?
Is the deficit true AOS or a type of paraphasia seen in pt’s w/ some aphasias?
Is the deficit AOS or just nonfluent language errors associated w/ Broca’s aphasia?