AOS CH 18

Question 1

What is the primary goal of AOS tx?

Answer 1

-mazimize the effectiveness, efficiency, and naturalness of therapy.

Question 2

tx should focus on?

Answer 2

-restoring or compensating impaired function and adjusting to the loss of normal speech

Question 3

tx of dysarthria vs. AOS focus?

Answer 3

improving the physiological support for speech whereas for AOS tx focuses on improving programming of speech

Question 4

why does aphasia often co-occur and influence tx?

Answer 4

• it affects a person’s ability to understand oral direction and their verbal expression
• may be difficult to determine if error is due to apraxia or aphasia
• may be best to work on language probs first before addressing apraxia

Question 5

what type of tasks should tx focus on ?

for progressive dz?

Answer 5

tasks that give the greatest and fastest benefit
-allow times for learning to be solidified
For progressive Dz? Goal is not to work towards improvement but to maximize communication.

Question 6

Medical approches to mx of AOS:

Answer 6

• no meds are used for apraxia, but managing must be used to treat underlying disorder.
• med treatments/surgeries used for dysarthria such as injections/ pharyngeal flap are NOT appropriate for AOS

Question 7

Prosthetic Mx/AAC:

Answer 7

prosthetic devices, such as palatal lift are usually not necessary b/c hyper nasality is not typically a severe problem in AOS….there can be expectations however,

• Pacing Devices may be of help to reduce rate of speech. (pacing boards, metronome, finger tapping)
• DAF has not typically been beneficial and has been disruptive to speech in its with co-existing Broca’s aphasia

Question 8

research has shown that working with what type of targets aids in generalization?

Answer 8

more difficult targets.

Question 9

If AOS is so severe that no sounds can be produced, what should you work on ?

Answer 9

-work on non-speech oro motor exercises (use targets that approximate speech movements (lip rounding, tongue to alveolar ridge, etc)

Question 10

What are some principles to motor learning?

Answer 10

-drill, drill, drill intensive and systematic drill essential to burn into motor program
(one on one therapy is best, can do group therapy only after one on one when max benefit has been achieved)
-stimuli should be carefully ordered (sound in syllable, sounds in words, etc.

Question 11

what should pts develop early on?

Answer 11

self monitoring and self correction early on.

Question 12

those who have to begin at a sound, syllable, or word level would benefit from what type of approach?

Answer 12

listen and watch me approach
-clinician models and explains what is to be done (using
phonetic placement information and cues for rate
and stress.
-fade cues asap
-use automatic speech to begin with-helps provide
success-have them count, say days of the wk.
-feeback is helpful- (have pt use mirror to develop strong
visual image of correct movement.
-use speech tasks if possible (non-speech tasks have
been found to be helpful unless the pt can’t make
syllables or sounds (if AOS is severe, focus on
sounds, syllable, or non-speech tasks for mute pts.,
focus on vegetative actions such as coughing,
laughing, humming, singing

Question 13

what should you do for intensive practice/therapy?

Answer 13

multiple reps of stimuli
-begin with consistent practice then go to variable. e.g. do 10 reps of stress on one syllable and then 10 reps on another syllable for consistent practice, then vary the conditions….

Question 14

reducing what will help improve accuracy?

Answer 14

reducing rate.

Question 15

Behavioral mx approaches:

Rosenebek’s 8 step continuum

Answer 15

1. Integral Stimulation- pt. listens and watches SLP as she makes sound/word then its imitates while SLP simultaneously produces target
2. Same as step 1 but pt.s response is delayed and clinician mimes the response without sound during pts. response
3. integral stimulation followed by imitation w/o any simultaneous cues from clinician
4. integral stimulation-with several successive productions w/o any intervening stimuli and w/o any simultaneous cues
5. written stimuli are presented w/o auditory or visual cues, followed by pt. production while looking at written stimuli.
6. written stimuli, with delayed production following removal of written stimuli. (count 10 seconds)
7. response elicted by question “what do you drink your coffee in?
8. response target produced in role play situation

Question 16

sound production tx (Wambaugh)

Answer 16

• uses minimal contrasts (bye-pie) to aid in refining movement patterns that differentiate sounds.
• works in hierarchy similar to 8-step continuum

Question 17

Prompts for restructuring oral muscular phonetic targets

PROMPTS

Answer 17

• developed for children with AOS but now used also with adults.
• tactile-kinesthetic input-highly structured finger placement on pts. face and neck tell the articulatory placement.
• usually used with severe AOS with very limited verbal output.

Question 18

Biofeedback

Answer 18

• may be useful in addition to other therapies but not by itself
• EMG Feedback may help for muscle relaxation
• Electromagnetic ariculography provides visual feedback about tongue positions

Question 19

Techniques for sound, syllable, and word level:

problems initiating phonation

Answer 19

-try yawning, sighing, coughing, and shaping phonation
from there
-put clinician’s hand on larynx and slightly depress (ask pt
to say /ah/)
-push in slightly on abdomen with patients mouth open to
elicit vocal fold closure and possible phonation.
May help to work on nonsense words
-work on isolated sounds then shape into words
(phonetic placement cues are especially helpful)

Question 20

What are some techniques at the multiple syllable level?

Answer 20

-focus on rhythm, stress, and intonation while concurrently working on articulation.
(use phonetic contrasts, bye/pie, sing/sting, to, chew)

Question 21

Rate and Rhythm Approaches:

Answer 21

• work on rate modification via pacing board, letter board, finger tapping, and metronome.
• finger counting: hold up one finger for each word uttered…
• prolonging vowel and stretching out words
• singing familiar songs
• melodic intonation therapy (MIT)

Question 22

What was MIT developed for?

Answer 22

non-fluent aphasia (not everyone is a candidate for MIT.

• must have good verbal comprehension, limited spontaneous verbal output, and good self-monitoring.
  (e. g. of good candidate = Broca’s Aphasic with oral apraxia and AOS)

Question 23

How does MIT work?

Answer 23

begins with hand tapping rhythms, then going to simultaneous humming with clinician, addition of words, phrases, and gradual fading of model.
-doesn’t use familiar tunes but emphasizes exaggerated pitch, tempo, and rhythm.
(eventually modified to spoken song, then speech)
-success due to pulling in right brain.

Question 24

What is a key word technique

Answer 24

use words correctly produced to gain control over speech by answering questions with the word, read the word etc. Then use the initial sound of this word to lead into another word.

Question 25

What is Multiple Input phoneme therapy?

Answer 25

1. used with several aphasic and apraxic its whose repetition abilities are impaired and who have frequent stereotypical words/phrases.
2. May aid in reducing struggle to speak voluntarily.
3. identify most frequently occurring stereotypes (such as go-go) and use this as target of tx.
4. Clinician produces target many time emphasizing initial phoneme, pt taps simultaneously.
5. pt then joins in repetitions
6. clinician fades voice but mouths utterances and tap as patient says targets.
7. repeat these steps for other stereotypical utterances. The idea is to say these stereotypical utterances voluntarily.
8. work on new words with the same initial phoneme as the stereotypical utterance
9. targets then broadened to include all phonemes.

Question 26

Voluntary Control of Involuntary Utterances (VCIU)

Answer 26

Similar to MIPT but relies on written as well as verbal input.
(Nancy Helms Estebrooks)

Question 27

Script Training:

Answer 27

-limited # of words/phrases learned and practiced in specific scripts. Used for moderately severe aphasia with AOS.

Question 28

Severe Apraxia (speechless techniques)

Answer 28

• use automatic speech tasks
• use carrier phrases “I drink Coffee in a Jar…………..”
• Singing familiar songs, Happy Birthday
• Pair symbolic gestures with associated sound/word (waving bye, OK sign, finger to lips for “sh”) these may help elicit words.