Apraxia Flashcards
What is apraxia?
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.
When can apraxia occur?
In the absence of physiologic disturbances associated with dysarthrias and in the absence of disturbance in any component of language.
What is the problem presented with apraxia?
Motor programming of speech movements
What is the problem presented with dysarthria?
muscles/ movement
What is the problem presented with aphasia?
linguistic/language
In what disorder are muscle okay? Apraxia or dysarthria?
Apraxia
Apraxia doesn’t involve ______ although it often co-occurs with _______ and ________.
language
aphasia and dysarthria
_______ does co-occur with aphasia but less often than _____ does.
Dysarthria
apraxia
_____ or _____ _____ may co-occur with apraxia of speech.
Oral or limb apraxia
Apraxia is almost always due to what?
left cerebral hemisphere damage so helps in localization of the lesion.
What are the steps in speaking?
- Speaker conceptualizes what is going to be said. This is where the message is determined.
- Speaker formulates the message through selecting semantic, syntactic, morphological, phonological structures for the message.
- The Motor Speech Programmer programs/plans the movements necessary to produce the needed phonemes. It activates a plan for the motor execution needed.
- This program is sent through the nervous system to produce muscle movement/motor execution.
If difficulties occur in (step 2) the speakers ability to formulate the message through selecting semantic, syntactic, morphological, phonological structures for the message it may be a result of ______.
Aphasia
If difficulties occur in (stepp 3) the ability for the motor speech programmer to program/plan the movements necessary to produce the needed phonemes it may be as a result of _______.
apraxia
If difficulties occur when (step 4) the program is sent through the nervous system to produce muscle movement/motor execution it may be a result of _______.
dysarthria
What are other names for apraxia of speech?
- speech apraxia
- oral verbal apraxia
Apraxia of speech is sometimes confused with what?
Broca’s aphasia
Why is apraxia of speech confused with Broca’s aphasia?
The phonologic impairment may be similar
Broca’s aphasia may include _____ but it involves more than ____.
AOS
Individuals with AOS do not have ______ problems that are seen in Broca’s aphasia.
linguistic
is the site of lesion for Broca’s aphasia and apraxia the same or different?
Both have similar sites of lesion.
Probably some of the speech problems people with Broca’s aphasia have are due to _____ problems and not always linguistic problems.
MSP (motor speech programmer)
What do you do when a client is suspected of apraxia and aphasia?
Always evaluate for both since they often co-occur.
What is the Motor Speech (MSP) programmer responsible for?
programming speech. It transforms the abstract phonemes to a neural code from which the motor programming can occur. The neural code determines the specific muscle movements needed.
Some of the specifics of the programming from the motor speech programmer possibly include:
- duration of movement
- amplitude of movement
- acceleration
- deceleration
- time t peak velocity
- timing of speech events
What is theorized about the motor speech plans?
That the motor speech plans are prepared before the muscle movement begins and that they are held in a buffer area. These plans can be modified before movement begins or during movement. This pre-planning is thought to be what allows us to have rapid speech.
What is thought to be what allows us to have rapid speech.
Pre-planning
Where is the motor speech programmer (MSP) thought to be located?
left cerebral hemisphere
The MSP is thought to be located in the left cerebral hemisphere. It is a theoretical system that involves several interacting structures and pathways in the left cerebrum. These structures are primarily located in the ___________ and related_______ ________.
Parietal-frontal
subcotical circuits
What do you need to have in order to know what to organize?
linguistic input
The linguistic input to the MSP comes mainly from the ________ area in the _____ _____.
What does it include?
perisylvian left hemisphere temporoparietal cortex, insula basal ganglia thalamus
What is the insula?
A cortical brain area that is buried within the lateral (sylvan) cerebral fissure.
The insula is hidden in the folds and can’t be seen unless you separate the ____ and _____ lobes.
temporal
frontal
What does the latest research odne by Dr. Robin and Dr. Wambaugh indicate about the insula?
It might not be involved in apraxia.
What has Dr. Robin found out?
That Brodman’s area 6 (pre-motor area) is an important area in aparxia and that damage in that area is associated with apraxia.
Name the specific areas that are thought to be primarily involved with the MSP:
- pre-motor area
- parietal lobe somatosensory cortex and supramarginal gyrus.
- insula
- basal ganglia
What is especially important for apraxia in the pre-motor area?
Broca’s area
Where are the lesions most often found in most people with apraxia?
Broca’s area
What area is not a common site of lesion for apraxia but may be involved sometimes?
Supplemental motor area
What are the pre-motor areas linked to for input?
basal ganglia and cerebellar circuits
Where do the pre-motor areas send connections for impulses to be sent on and put into place by the motor speech program?
motor area
Why do pre-motor areas send connections to the motor area?
For impulses to be sent on and put into place by the motor speech program.
Why are the parietal lobe somatesonsensory cortex and supramarginal gyrus important?
They integrate sensory information that is needed for skilled motor activity.
What is an area that is a frequent site of lesion for peole wth apraxia and sometimes the only site of lesion. However, apraxia can occur without lesions in this area.
Insula
The importance of the insula for apraxia has been questioned. True or False.
True
The basal ganglia is also thought to be important in MSP. Lesions in the striatum, _____ and _____ ____ are common in people with AOS.
putamen
caudate nucleus
What are the most common sites of lesion in AOS?
Left posterior frontal lobe area (Broca’s) (insula?) and (basal ganglia).
What are non-speech characteristics that may accompany AOS and reflect left hemisphere damage?
- some right sided weakness and spasticity
- Babinski reflex and hyperactive stretch reflexes
- sometimes limb apraxia is present
What is limb apraxia associated with?
Left hemisphere pathology although if it is present in both right and left sides but may be masked on the right side by hemiparesis or hemiplegia.
Since MSP is thought to be located in the left hemisphere it may influence what?
all motor movement
What are the etiologies for apraxia of speech?
- anything that causes dominant hemisphere impairment of structures involved in motor planning.
- Tumors
- trauma
- stroke
What are patient’s complaints and perception with apraxia of speech?
Can’t pronounce words right-they know what they want to say but the words won’t come out right. They may indicate it worsens in stress.
Patients with AOS alone do not typically have problems with _______. If patients do complain of _____, neuromuscular problems may exist which would implicate ______ as well as _______.
swallowing
swallowing
dysarthria
dysphagia
If patients complain of swallowing, nueromuscular problems may exist which implicates what?
dysarthria as well as dysphagia
What should be the clinical findings during an oral mechanism for a client with apraxia?
if dysarthria does not co-occur, gag reflex, chewing and swallowing should be WNL. Similarly, there should no pathological oral reflexes or tongue weakness without dysarthria.
-note whether oral sensation is impaired.
are auditory processing skills affected in patients with AOS?
Auditory processing skills are normal in patients with AOS but direct auditory feedback can cause more severe breakdowns in individuals with AOS and Broca’s aphasia than in normal speakers.
What kind of voluntary speech tasks are used to elicit AOS?
conversational
speech
narratives
reading
What kind of tasks do patients with AOS tend to breakdown?
Tasks that require sequencing of various sounds and syllables such as:
sequential motions rate (SMRs) and multisyllabic words and sentences.
How can you determine if the problems are due to aphasia or apraxia?
Have the patients do imitation tasks to reduce the need for word retrieval or other kinds of word formulation which may be a problem if aphasia co-exists.
patients may do ok with what kind of tasks?
Speech tasks that are over-learned:
counting, days of week, familiar phrases.
They have become automatic and non-volitional.
During a speech assessment in patients with apraxia listen for _______ _______ ______ and watch for ______ of articulators.
false articulatory starts
groping
Patients with severe AOS may not be able to do many of speech tasks. What should you do?
Try to elicit any speech response and determine what they can do?
What is the primary articulation error for patients with apraxia of speech?
distortion. It may be a perceived substitution but it is actually a distortion.
_______ is a key problem with consistent errors occurring in apraxia.
Articulation
What is one difference from the paraphasias that occur in aphasia and the articulatory distortions that occur in AOS?
In paraphasias, there is usually no distortion.
Aritculation problems in patients with apraxia are greater on _____ than _____ ______.
blends
single consonants
____ and ______ problems are very common in AOS?
Rate
prosodic
How is fluency affected in patients with apraxia of speech?
It becomes abnormal as individuals start and stop repetitively in attempts to self-correct and produce words correctly.
What is the most important diagnostic criteria for apraxia of speech?
- slowed rate of speech-segmentation of syllables (increased interval time between syllables)
- sound errors (distortions, consistent, predictable
- prosodic abnormalities
What may happen with a person who has severe AOS?
May not initially be able to phonate and may be mute. May not last too long, most can phonate after 2 weeks.
If muteness lasts longer than 2 weeks in a client with apraxia what should clinician consider?
Another diagnosis such as severe aphasia, anarthria or psychogenic mutism.