L18: Apraxia of Speech Flashcards
Apraxia is…
an impairment in the ability to perform preplanned, volitional, purposeful movements or gestures
apraxia can occur in the absence of…
paralysis or weakness, sensory loss, comprehension deficits or ataxia
In apraxia, despite adequate strength and speech and movement the pt produces…
these movements are unlike….
gestures that are very difficult to recognize due to abnormal positioning of body parts and incorrect actions
these abnormal movements are unlike involuntary movements because they appear to be purposeful
In apraxia it is as though the components of a movement have been incorrectly…
selected and sequenced
apraxia is often associated with _____ damage
left hemisphere damage (especially oral/verbal apraxias, limb apraxia may be more severe)
damage in apraxia is often to regions of the cortex and subcortex that are involved in…
the planning or programming of complex volitional movements
most of the important areas for apraxia are in the frontal lobe and include:
each of these areas eventually connects to the …
1) the lateral premotor cortex,
2) the insula,
3) the internal capsule, and
4) the pathways connecting the parietal lobe to the frontal lobe
all eventually connect to the motor cortex
the motor cortex is presumed to be responsible for…
executing the movement plan (basic neuromuscular details)
limb + oral apraxia can be described as
an example?
an inability to efficiently and immediately perform oral/limb gestures on verbal command and/or imitation
eg. “ Show me how you would “ wave goodbye, salute, use a hammer, use a toothbrush, kiss a baby, blow out a match, whistle, etc.
name other symptoms of apraxia (try to name 3 there are many)
groping and multiple attempts at a movement
spatial errors
inaccurate positioning of a body part
substitution of one action for another
delayed initiation of a movement
pauses during a movement (fragmentation of movement)
additional movements
abnormal sequencing of movements (transpositions)
perseveration of movements
body part as object
subtypes of limn and oral apraxia have been proposed such as…
subtypes are define in relation to…
(ie. ideational, ideomotor, limb-kinetic, kinesthetic, constructional, etc.)
subtypes are defined in relation to performance on different types of tasks or because of certain types of errors
what types of errors are subtypes defined by?
command versus imitation
imitation of object use versus real object use
single gestures versus sequences of gestures
simple versus complex gestures
presence of perseverations
presence of groping
ideational apraxia involves…
sequences, verbal commands, and real objects
ideomotor apraxia involves
single gestures, imitation, groping
there is _____ agreement in the lit on the diagnosis of these subtypes, some believe…
very little
some believe the subtypes represent different levels of severity or the presence of additional deficits (ie. aphasia, memory deficits, sensory deficits, etc.)
oral, limb, verbal apraxia can all occur in ____
oral and verbal tend to occur _____
limb occurs with….
each can occur in isolation
oral and verbal tend to occur together most frequently (about 60-80% of pts)
limb occurs with oral or verbal in about 30% of pts
apraxia of speech is…
it involves no….
Impairment in the capacity to program the positioning of the speech musculature and the sequencing of muscle movements for the volitional production of phonemes
An impaired capacity to form vocal tract configurations and to make transitions between vocal tract configurations for volitional speech production, in the absence of motor impairments for other actions using the same musculature
No significant weakness, slowness, or incoordination in reflex and automatic acts
how is dysarthria different from AOS?
fairly consistent errors (AOS highly variable errors)
distortions more than substitutions (AOS frequent substitutions)
errors often simplifications (AOS errors often complications)
automatic nonspeech oral movements impaired (AOS less impaired)
how is AOS different from aphasia?
language comprehension normal in AOS
word finding normal in AOS
written language has normal syntax and semantics
often co-occurs with Broca’s aphasia but AOS can occur in ‘pure’ form (13% of pts)
What are the % of apraxia, apraxia + aphasia, apraxia + dysarthria, and apraxia+ dysarthria+ aphasia?
apraxia only 13%
apraxia & aphasia 65%
apraxia & dysarthria 8%
apraxia, dysarthria & aphasia 14%
AOS is most often caused by… (give percentages)
degen diseases 61%
vascular/stroke 25%
AOS is most often damage to the _____ areas involving:
left frontal areas:
1) the lateral premotor cortex,
2) the insula,
3) the internal capsule, and/or
4) the pathways connecting the parietal lobe to the frontal lobe
Note: Broca’s area (44) does not have to be involved for AOS
what are the 4 of 8 rly important characteristics of AOS?
- Effortful groping for correct articulatory postures, at times with facial grimacing.
- Inconsistent articulatory errors
- Alteration of prosody and rate.
- Difficulty initiating utterances.
what are the total 8 characteristics of AOS?
- Effortful groping for correct articulatory postures, at times with facial grimacing.
- Consonants more involved than vowels, and clusters more involved than singletons.
- Inconsistent articulatory errors
- Substitutions, additions, repetitions primarily; less frequently distortions or omissions.
- Majority or errors are close approximations of the target. (Place errors more frequent than manner & voicing errors)
- Perseverative, anticipatory, and transposition errors.
- Alteration of prosody and rate.
slow rate, even stress, schwas inserted into consonant clusters, intersyllabic pauses, etc.
- Difficulty initiating utterances.
what are 6 other possible characteristics of AOS?
- Frequently occurring sounds more likely to be correct.
- Meaningful utterances produced more accurately.
- More errors on longer words.
- Automatic utterances better than volitional.
- Imitation may be better than spontaneous speech.
- Patients are very aware of their articulatory errors.
what are the common distinctive cues for the presence of AOS?
distorted sound substitutions and additions,
- segregation of syllables in multisyllabic utterances,
- attempts to correct articulatory errors that cross phonemic boundaries,
- groping for articulatory postures,
- greater difficulty on volitional versus automatic speech
- greater difficulty on multisyllabic word tasks versus single-syllable tasks
- greater difficulty on SMR (p, t, k) versus AMR tasks (p-p-p)
variable errors in AOS may be very noticeable over..
repeated productions of a word
these may be more complex errors rather than simplifications
in AOS substitutions and additions are often…
distorted so they are heard as distorted substitutions and additions
more errors in AOS on
longer and more complex words
in AOS you may find intrusive…
schwas, syllable segmentation and syllable lengthening (slow rate and prosodic abnormality)
