Chapter 18-Managing Apraxia of Speech

Question 1

Not all individuals are candidates for intervention

Answer 1

Aphasia very often co-occurs and influences treatment because it affects the person’s ability to understand oral directions and their verbal expression.

Question 2

Medical

Answer 2

No meds are used for apraxia but may be used to treat underlying disorder.

Question 3

Medical

Answer 3

Medical treatment/surgeries used for dysarthria such as pharyngeal flap are not appropriate for AOS.

Question 4

Prosthetic management/AAC

Answer 4

prosthetic devices such as a palatal lift are usually not necessary because hyper nasality is not typically a problem in AOS.

Question 5

Prosthetic management/ AAC

Answer 5

pacing devices may help to reduce rate of speech. DAF has not typically been beneficial and has been disruptive to speech in patients with co-existing Broca’s aphasia.

Question 6

Prosthetic management/ AAC

Answer 6

AAC aids such as letter boards may help, as well as dedicated AAC devices.

Question 7

Behavioral management

Answer 7

Drill Drill Drill- intensive and systematic drill is essential to burn in motor program. One on one therapy is the best. intensive practice/therapy- use multiple repetitions of stimuli.

Question 8

Behavioral management

Answer 8

pts need to develop self-monitoring and self-correction skills early. Those who begin at the sound, syllable, or word level can benefit from a “listen and watch me” approach. The clinician models and uses phonetic placement and cues for rate and stress.

Question 9

Behavioral management

Answer 9

Use automatic speech to begin with- helps provide success. Feedback is helpful have pt use mirror to develop strong visual image of correct movement. For mute pts focus on vegetative actions such as coughing, laughing, humming and singing. I want to laugh and sing :)

Question 10

Rosenbek’s eight step continuum

Answer 10

1. integral stimulation- pt watches the SLP say word then the pt imitates while SLP simultaneously produces target word.
2. the clinician mimes the response without sound during the pt’s response.

Question 11

Rosenbek’s eight step continuum

Answer 11

3. Imitation without any simultaneous cues from the clinician- the clinician is not saying the target word with the client.
4. several successive productions with any cues from the clinician. i.e. bed, bed, bed, bed, bed.

Question 12

Rosenbek’s eight step continuum

Answer 12

5. written stimuli is introduced with no cues.
6. written stimuli is shown but then removed.
7. response elicited question i.e. what do you sleep on?
8. response target produced in role play situation.

Question 13

Sound production tx

Answer 13

(SPT )wambaugh- uses minimal contrast (bye/pie)

Question 14

Prompts for restructuring oral muscular phonetic targets (PROMTS)

Answer 14

tactile-kinesthetic input- highly structured finger placement on pts face and neck tell the articulatory placement. Usually used with severe AOS patients with very limited verbal output.

Question 15

Melodic Intonation Therapy (MIT)

Answer 15

developed for nonfluent aphasia that have good verbal comprehension, limited spontaneous verbal output, good self monitoring skills. A good candidate would be Broca’s aphasic with oral apraxia and AOS. MIT begins with hand tapping rhythms then going to simultaneously humming with clinician, addition of words, phrases, and gradual fading of model. does not use familiar tunes but uses exaggerated pitch, tempo and rhythm. Success to pulling in the right brain.

Question 16

Biofeedback

Answer 16

May be useful in addition with other techniques but not by itself. EMG feedback may help for muscle relaxation. Electromagnetic articulography provides visual feedback about tongue positioning.

Question 17

Severe apraxia techniques

Answer 17

use automatic speech task, uses carrier phrases such as “ I drink coffee in a . singing familiar songs such as happy birthday, jingle bells. for problems initiating phonation try yawning and coughing. pair symbolic gestures with associated sound or word (waving goodbye, ok sign finger to lips for “sh”.

Question 18

techniques for sound, syllable, and word

Answer 18

may help to work on nonsense words rather than words that carry meaning. Work on isolated sounds then shape them into words, hum then prolong this to “ma” then add final consonant so you have cvc. key-word technique- use words correctly produced to gain control of speech by answering questions with the words , reading the word etc. Then use the initial sound of this word to related to another word.

Question 19

Multiple Input Phoneme Therapy (MIPT) similar to voluntary control of involuntary utterances exempt VCIU uses written as well as verbal output.

Answer 19

Used with several aphasic and apraxic pts whose repetitions abilities are impaired and who have frequent stereotypical words/phrases. Identify most frequently occurring stereotypical word and use this as a target in treatment. 1. clinician produces target word many times emphasizing the initial phoneme 2. patient then joins in with the repetitions 3. clinician fades voice but mouths the target word 4. repeat these steps for other stereotypical words/phrases 5. then work on new words with the same initial phoneme as the stereotypical utterance.