Apraxia of speech Flashcards
Greek praxis means
action or purposeful action
- putting theories into practices
Definition of apraxia
- reflexive and automatic speech are relatively unaffected
- not from muscular weakness, muscular slowness, or muscular incoordination
ideomotor apraxia definition
they have the idea of what to do but does not have the ability to carry out the motor plan needed to use an object or make a gesture
- mostly seen in clinical settings
ideational apraxia definition
they forget what to do with objects; cannot make proper use of an object or gesture because they no longer know its purpose
ideomotor apraxia movements
- affects voluntary movements (on the cortex)
- movements might be easier with real objects
- movements are easier with gestural commands (i.e. imitation) than verbal commands
- movement sequencing is often inconsistent
limb apraxia
the inability to sequence movements of limbs during a voluntary action:
- brushing teeth
- writing a letter
- combing hair
nonverbal oral apraxia
- affects nonverbal, voluntary movements of tongue, lips, jaw, etc.
- whistling
- puffing out cheeks
- swallowing
- groping: trial and error searching behaviors
- hesitations
- incomplete or incorrect movements: lick lips and stop
- extra movements
- not usually seen in spontaneous or reflexive movements
- often co-occurs with AOS (60%)
Apraxia of speech
Definition: inability to accurately sequence motor commands needed to correctly position the articulators during voluntary production of phonemes
- L frontal lobe damage; perisylvian region
- often co-occurs with Broca’s aphasia and/or dysarthria
motor speech programmer
- hypothetical construct
- L perisylvian area
- connections with other areas
- close ties to Broca’s area
- existence is largely inferred
** we are rapidly sequence speech movements
** deficits offer damage to L hemisphere
etiologies of AOS
- stroke: 58% of cases in Mayo clinic study
- degenerative diseases: 16% (alzheimer’s disease)
- TBI: 15% (usually, surgical trauma)
speech characteristics
- articulation and prosody, primarily
- speech is often labored and halting
- articulatory groping - groping for the sound
- inconsistent errors
- maybe nearly mute in severe case
** searching for placement
** AOS is highly variable in severity
Articulation errors
- phonemic substitution
- errors of place - not that much omission for adults
- anticipatory
- perseveration
- metathetic
- fricatives & affricates are difficult
- errors are common in initial position
- low-frequency words are more difficult
- non-sense words are more difficult
- multi-syllabic words are more difficult
- distance between places of articulation
- voluntary speech is harder than automatic speech
- errors are inconsistent
- labial & lingual-alveolar are easier than other places of articulation
- consonant clusters are harder
anticipatory
e.g. “lelo” for “yellow”
- the sound in the back of the word coming to the front
perseveration
e.g. “bababa” for “banana”
- front to back coarticulation
metathetic
e.g. “hitsory for “history”
- two consonants that are together are transposed
- doesn’t need to be next to each other
prosody errors
- slow speech rate (hesitation, prolonged phonemes)
- equal syllable stress
- silent pauses before or between syllables
- reduced pitch and loudness variability
- prosody is affected by articulation problems or compensatory
standardized test
ABA - apraxia battery for adults
- gives severity levels
- limb apraxia
- oral apraxia
- AOS
- not long, takes about 30 mins
evaluation of AOS - specific tasks
- repetition of words & sentences
* or read, if repetition deficit (e.g. some aphasias) - count from 1-20
- count backward from 20-1
- picture description - “cookie theft picture”
Treatment of AOS
- primarily behavioral (maybe AAC, if severe)
- drugs
- surgeries
- intensive individual sessions
** some more mild patients might be good candidates for an aphasia group - sessions tend to be time-intensive, repetitive, and highly structured
** depends on severity and presence of aphasia - patients with strokes often have pressure pills, to help
general principles of treatment
not all AOS patients are good treatment candidates
- treat language first
- depends on severity of language impairments
** work on receptive language first
** to have enough comprehension to start working on oral
** training gestures or AAC might be needed
repetition and intensive drill
maintain a high success rate
self-monitoring of speech
focus on functional words ASAP
spot check your stimuli
MIT (Helm-Estabrooks)
Melodic Intonation Therapy
- good for both aphasia and AOS
- attempts to use RH (rhythm and melody)
- intonation is modified into a more natural prosody (similar to choral reading)
- usually, not a treatment for prosody, but using the prosody to get the artic
- “approximate” and “best” are two different things
- pick sentences that they need to use in daily life
Appropriate candidates for MIT
- left CVA
- restricted verbal output
- good auditory comprehension
- poor articulation
- poor repetition abilities
- good motivation and attention span
MIT - phase 1
- humming
- Unison singing
- Unison singing with fading
- Immediate repetition
- Response to a probe question
MIT - phase 2
- introduction to item
- unison with fading
- Delayed repetition
(Backup: Unison with fading) - Response to probe repetition
(Backup: Delayed repetition)
MIT - phase 3
- Delayed repetition
(Backup: Unison with fading) - Introducing sprechgesang
- Sprechgesang with fading
(Backup: Unison sprechgesang) - Spoken repeition with delay
(Backup: sprechgesang with fading) - Response to probe question
(Backup: Delayed repetition)
DAB - initiating speech activities
- begin with /a/ vowel, using cough or sign if necessary
- add other vowels
- next, /m/ is trained and then put into syllables using vowels
- words can then be alternated (e.g. moe-me)
DAB - using automatic response
- counting
- reciting days of week
- common expressions
- nursery rhymes, prayers, songs
- songs are awesome; it’s automatic and kicking it in the atomsphere
DAB - phonemic drill
- integral stimulation: integrating the stimulation - asking clients to do what I do
- increase complexity of utterances containing targeted phonemes
Example of phonemic drill
- choose phoneme & produce: /m/
- CV words: my, may, met, etc.
- CV words are doubled (reduplicated): me-me, my-my
- CVC: mom, mime, etc.
- Words: more, mine, men, etc.
- Two-word phrases, both words begin with target: my mom, more mail
- Two-word phrases, both words end with target: come home, name him
- Target is in initial in first word, in final in second word: my home
- Phrases with/multisyllabic words: moment by moment
Rosenbek’s Eight-Step Continuum
- move from repeating target phonemes in unison with clinician to independent productions of utterances during role-playing
- begin with easiest speech sounds
- especially initial sound
- try to use high-frequency words
Rosenbek’s Eight-step
- clinician and patient say target word in unison
- clinician mouths word, patient says the word aloud
- patient repeats word after clinician
- patient repeats word several times
- patient says word while looking at written stimulus
- Clinician presents written stimuli, removes, and patient says the word
- Patient responds to clinician’s probe question
- Role playing using the target word
Sound production treatment
- based on Rosenbek’s (but fewer steps)
- many common strategies
- repetition, integral stimulation, modeling, phonetic placement cues, feedback
- but steps go from hardest to easiest
SPT: Basic Steps
- produce target word or phrase following verbal model
- repeat step 1, but with a written cue
- produce target word with integral stimuli (up to three attempts allowed)
- produce target word with placement cues and modeling
- produce target sound in isolation with a model
- next item
- whenever the client gets one correct, go back to step 1
- it’s for clients that can at least produce CV
