Chapter 11 Apraxia

Question 1

Apraxia of Speech (AOS)

Answer 1

Problem with the motor programming of speech movements

Question 2

What does AOS co-occur with?

Answer 2

Often co occurs with aphasia and dysarthria.

-also oral and limb apraxia

Question 3

What is AOS almost always due to?

Answer 3

Left cerebral hemisphere damage

Question 4

4 steps in speaking:

Answer 4

1. Speaker conceptualizes what is going to be said. This is where the message is determined.
2. Speaker formulates the message through selecting semantic, syntactic, morphological, phonological structures for the message.
3. The Motor Speech Programmer programs/plans the movements necessary to produce the needed phonemes. It activates a plan for the motor execution needed.
4. This program is sent to through the nervous system to produce muscle movement/motor execution.

Question 5

If difficulties occur in step 2

Answer 5

the result may be aphasia

Question 6

If difficulties occur in step 3

Answer 6

the result may be apraxia

Question 7

If difficulties occur in step 4

Answer 7

the result may be dysarthria

Question 8

Motor Speech Programmer (MSP)

Answer 8

Located in the parietal-frontal lobes and related subcortical circuits responsible for programming:
•	Duration of movement
•	Amplitude of movement
•	Acceleration
•	Deceleration
•	Time to peak velocity
•	Timing of speech events.

Question 9

Areas primarily involved with the MSP

Answer 9

• Pre-motor area (Broca’s area)
• Supplemental motor area
• basal ganglia and cerebellar circuits
• Parietal lobe somatosensory cortex and supramarginal gyrus
• insula
• basal ganglia (putamen and caudate nucleus)

Question 10

Primary site of lesion for AOS

Answer 10

left posterior frontal lobe (Broca’s area, insula, and basal ganglia)

Question 11

Non speech characteristics of AOS

Answer 11

• Right sided weakness and spasticity
• Babinski reflex and hyperactive stretch reflexes
• limb apraxia (left side prominent due to right side hemiparesis/hemiplagia)

Question 12

Primary etiologies of AOS

Answer 12

Tumors
Trauma
Stroke
(that affect the left hemisphere)

Question 13

Patient complaints of AOS

Answer 13

Can’t pronounce words correctly even though they know what they want to say

Question 14

Clinical findings for AOS: Oral Mechanism Exam

Answer 14

Without dysarthria; gag reflex, chewing, swallowing, pathological oral reflexes should be WNL

Question 15

Clinical findings for AOS: Non Verbal Oral Apraxia (NVOA)

Answer 15

Problems with involuntary movements of non verbal oral structures during performance of volitional tasks

Question 16

Clinical findings for AOS: Auditory processing skills

Answer 16

Auditory processing skills are WNL however with DAF more severe breakdowns occur than with normal speakers

Question 17

Clinical findings for AOS: Speech

Answer 17

• Use voluntary speech tasks (conversation, narratives, reading)
• Sequencing of syllables (SMRs, multisyllabic words)
• Increase morphological complexity of words (endear/ing/ly)
• Listen for false articulatory starts
• Watch for groping of articulators
• For more severe AOS try to elicit any speech responses
• Primary articulation error is distortion especially on blends
• Rate and prosodic problems
• Fluency due to attempts to correct errors

Question 18

Most important diagnostic criteria for AOS

Answer 18

• Slowed rate of speech
• Consistent predictable sound errors (distortions)
• Prosodic abnormalities