L4 Apraxia of Speech

Question 1

what do we need to find out in a case history

Answer 1

• Baseline speech – developmental stutter; pre-existing aphasia, dysarthria; inter-dentalisation
  
  • Ask for videos or voice notes from pre-incident
• Baseline literacy – important for assessment and therapy
• Native language
• Lesion location
• Hearing? Vision (pre- and post-lesion)?
  
  • We need to know how well they can hear us/see materials
• Other neuro issues post-lesion: Hemiparesis - one side of the body paralysis/weakness, Limb apraxia, Ideomotor apraxia - can’t use objects correctly
• Social history: family, occupation, roles, interests, personality

Question 2

why is oro-facial examination especially important

Answer 2

• to determine if they can perform volitional non speech movements

Question 3

perceptual speech tasts

Answer 3

• automatic speech
• repetition
  -narrative sample
  reading aloud

Question 4

perceptual assessment of automatic speech tasks

Answer 4

(eg. counting to 20, days of the week)
- This is an easy task - so ingrained in your muscle memory that there isn’t that much planning involved
- It’s great because patients are more than likely going to be able to at the very least a little bit of it - this settles patients, gives them a sense of acheivement and confidence
- Also a good task for differential diagnosis - will remain difficult with aphasia or dysarthria

Question 5

perceptual assessment - repetition

Answer 5

• monosyllabic words
• multisyllabic words
• words of increasing length (jab, jabber, jabbering)
• sentences
• the longer the utterance the worse the speech will be due to increased planning load

Question 6

perceptual assessment - narrative sample, reading aloud

Answer 6

• assesses connected speech
• especially important for prosody

Question 7

compare repetition vs propositional speech vs reading

(results)

Answer 7

• Repetition is easiest - less planning load
• Reading next - sounds are there but they need to link letter to sound
• Propositional speech is hard - have to think language, and then plan and programme sounds
• More planning load - worse performance, good sign of AOS

Question 8

other assessments

Answer 8

• Assess overall speech intelligibility – this is often a useful outcome measure to complete pre- and post-therapy
  
  • No formal assessment for AOS - you can use AIDS (dysarthria)
  • ask client to self rate
  • • Expressive and receptive language assessments should be completed if indicated
  • Is there aphasia present- what type? How severe is it?
• Cognitive assessments/non-verbal reasoning – liaise with OT, Psychology and medical colleagues
• Written language assessment – establishing written language ability is important if AAC is needed to supplement verbal output
• Can the person understand written words? Can they write?

Question 9

formal assessments for AOS

Answer 9

• Apraxia Battery for Adults (ABA) (Dabul, 1986, 2000)
  
  • Uses a range of tasks to elicit speech features considered characteristic of AOS… BUT based on diagnostic criteria which were developed in 1980s
  • Updated diagnostic criteria have been published since, which have undermined the usefulness of this as a reliable way of diagnosing AOS, however it contains useful tasks and stimuli for assessment
  • See further discussion in McNeil et al., 2004, p. 394.
• You can adapt formal assessments from other fields depending on what aspect of speech you want/need to assess
  
  • e.g. Assessment of Intelligibility of Dysarthric Speech (AIDS, Yorkston and Beukelman, 1981)

Question 10

how to differ between AOS and aphasia

Answer 10

• Significant overlap with phonological aphasia, with many common features
• Sound distortions are present in both but much more frequent in AOS than aphasia
• Prosody typically not affected in aphasia but core feature of AOS