AOS and assessment Flashcards
What is apraxia of speech?
A neurologic speech disorder that reflects an impaired capacity to plan or program sensorimotor commands necessary for directing movements that result in phonetically and prosodically normal speech. It can occur in the absence of physiologic disturbances associated with dysarthria, and in the absence of disturbance in any component of language
CAS vs AOS
- Both defined by difficulties in motoro planning
- In CAS children might not be aware of errors, but adults with acquired AOS may try to correct themselves
- Adults have more existing pre-programmed automatic speech
Acquired AOS aetiologies
Damage to the speech network of the dominant hemisphere
- Stroke, most common
- Degenerative disease
- Trauma (TBI, surgical)
- Neoplastic (tumour)
Where is AOS localised?
- Insula = subcortical region under Broca’s area, sensory integration area, putting together what the mouth is doing vs what needs to be done
- Initially thought it was purely a deficit in the insula causing AOS
- Another study found lesions in posterior frontal gyrus
- PFG might be more acute and insula might be more chronic long-lasting effects
- Transcranial magnetic stimulation of the lateral premotor cortex induced apraxia-like speech in adults
Speech features of AOS
- Inconsistent articulatory errors
- Increasing errors with length/complexity
- Automatic speech often better
- Consonant and vowel distortions
- Distorted substitutions/additions
- Groping for places of articulation
- Sound prolongations
- Syllable segmentation
- Prosodic impairment
Co-occuring impairments with AOS
Non-verbal oral apraxia, dysarthria
Non-verbal oral apraxia
- Inability to imitate/follow commands to perform volitional movements of speech structures (not poor comprehension or neuromuscular deficit)
- 48-85% people with AOS
Dysarthria
- 30% also have dysarthria,
- Most commonly UUMN or spastic
Aphasia
- 65% also have aphasia
- Most commonly Broca’s
AOS vs dysarthria
- Error type: distorted substitutions/additions/prolongations/repetitions vs distortions + omissions
- Consistency: variable errors vs errors consistent across utterances
- Automaticity: automatic speech may be near normal vs less affected by automaticity
- Length effects: strongly affected vs more consistent across different lengths
- Groping: often present vs typically not
- DDK: SMR poorer than AMRs vs SMRS equal to AMRs
Dysarthria vs apraxia
- Error type: distorted substitutions/additions/prolongations/repetitions vs distortions + omissions
- Consistency: variable errors vs errors consistent across utterances
AOS vs aphasia
- Motor control: definite motor involvement vs no evidence
- Error type: distortions/substituted distortions vs clear phoneme level errors
- Error correction: recognise and attempt to correct artic errors vs likely to go unnoticed (not always)
- Speech rate: slow rate/difficulty with increasing rate vs normal rate
- Prosody: impaired, errors on stressed syllables vs intact, little relation between stress and error rate
Assessment of AOS (4)
- Bedside exam: OPE and speech tasks
- Apraxia Battery for Adults - 2 (ABA-2)
- Apraxia Speech Rating Scale (ASRS)
- AOS bedside exam: OPE
- Lip/jaw/tongue movement: coordination, strength, range, rate, groping?
- Blow
- Whistle
- Chatter teeth
- Click tongue
- Cough/clear throat
- AMR and SMR
- AOS bedside exam: speech tasks
- Speech sample: conversational, cookie theft, passage
- Words of increasing length: eg. thick, thicken, thickening
- Sentence repetition
- Automatic speech: days of week, counting
- ABA-2
Tasks:
1. DDK
2. Increasing word length
3. Assessing limb and oral apraxia
4. Timing of latency and utterance for polysyllabic words
5. Repeated trials of same word
6. Inventory for AOS behavioural characteristics
Provides a score to compare with norm data
- ASRS
- Describes and quantifies characteristics indicative of AOS
- 5 point scale for presence/absence of characteristics, prominence and severity
- Scored after listening to different tasks: conversational, picture description, word/sentence repetition, speech-like AMR/SMR tasks
