Managing Apraxia of Speech Flashcards
Why might not all individuals are candidates for intervention?
- Aphasia very often co-occurs and influences treatment because it affects a person’s ability to understand oral directions and their verbal expression – so that it is difficult to determine sometimes if the error is due to apraxic problems or aphasia
- It may be best to work on the language problems first before working on apraxia
Medical management of apraxia of speech:
o No meds are used just for apraxia but may be used to treat underlying disorder.
o Medical treatments/surgeries used for dysarthria such as Teflon injection, pharyngeal flap are not appropriate for AOS.
Prosthetic Management/AAC of apraxia of speech (3):
1 Prosthetic devices such as palatal lift are usually not necessary because hypernasality is not typically a severe problem in AOS. There can be exceptions however.
2 Pacing devices may be of help to reduce rate of speech (pacing boards, metronome, finger tapping). DAF has not typically been beneficial and has been disruptive to speech in patients with co-existing Broca’s aphasia.
3 AAC aids such as letter boards may help, as well as dedicated AAC devices
Behavioral Management of apraxia of speech:
– all behavioral management approaches emphasize careful selection of stimuli, orderly progression of treatment items and intensive and systematic drill.
- usually a very structured, orderly approach
Principles of motor learning apply (behavioral management of apraxia of speech (9):
- Drill, drill, drill – intensive and systematic drill is essential to burn in motor program. One on one therapy is best. Can do group therapy only after one on one, when maximum benefit has been achieved.
- Patients need to develop self-monitoring and self-correction skills early (remind them to monitor. Say “how was that, did that sound like a good one?”)
- Those who have to begin at sound, syllable, or word level can benefit from a “listen and watch me” approach. (We don’t know why this works but it does.)The clinician models and explains what is to be done, using phonetic placement information and cues for rate and stress. Fade cues as soon as possible
- Use automatic speech to begin with – helps provide success – have them count, say days of week, etc.
- Feedback is helpful – have patient use mirror to develop strong visual image of correct movement.
- Use speech tasks if possible. Nonspeech tasks have not been found to be helpful unless the patient cannot make syllables or sounds. When AOS is severe, focus on sound, syllable or nonspeech task. For mute patients, focus on vegetative actions such as coughing, laughing, humming, singing.
- Intensive practice/therapy - use multiple repetitions of stimuli.
- Begin with consistent practice, then move to variable (do 10 reps of stress on one syllable, then 10- reps of stress on another syllable for consistent practice, then vary the conditions.) (consistent = teaching. Inconsistent = more realistic)
- Reduce rate to improve accuracy. Once articulation is accurate then try to return to normal rate.
Rosenbek’s Eight Step Continuum (behavioral management of apraxia of speech) (8):
- Integral stimulation – patient listens and watches SLP as she makes sound/word then patient imitates while SLP simultaneous produces target.
- Same as step 1 but patient’s response is delayed and the clinician mimes the response without sound during the patient’s response.
- Integral stimulation followed by imitation without any simultaneous cues from clinician
- Integral stimulation with several successive productions (e.g. 3) without any intervening stimuli and without simultaneous cues.
- Written stimuli are presented without auditory or visual cues, followed by patient production while looking at written stimuli.
- Written stimuli, with delayed production following removal of written stimuli. (count 10 seconds).
- Response elicited by question, “What do you drink your coffee in?”
- Response target produced in role play situation.
Principles of motor learning apply (behavioral management of apraxia of speech (9):
- Drill, drill, drill – intensive and systematic drill is essential to burn in motor program. One on one therapy is best. Can do group therapy only after one on one, when maximum benefit has been achieved.
- Patients need to develop self-monitoring and self-correction skills early
- Those who have to begin at sound, syllable, or word level can benefit from a “listen and watch me” approach. (We don’t know why this works but it does.)The clinician models and explains what is to be done, using phonetic placement information and cues for rate and stress. Fade cues as soon as possible.
- Use automatic speech to begin with – helps provide success – have them count, say days of week, etc.
- Feedback is helpful – have patient use mirror to develop strong visual image of correct movement.
- Use speech tasks if possible. Nonspeech tasks have not been found to be helpful unless the patient cannot make syllables or sounds. When AOS is severe, focus on sound, syllable or nonspeech task. For mute patients, focus on vegetative actions such as coughing, laughing, humming, singing.
- Intensive practice/therapy - use multiple repetitions of stimuli.
- Begin with consistent practice, then move to variable (do 10 reps of stress on one syllable, then 10- reps of stress on another syllable for consistent practice, then vary the conditions.)
- Reduce rate to improve accuracy. Once articulation is accurate then try to return to normal rate.
Rosenbek’s Eight Step Continuum (behavioral management of apraxia of speech) (8):
- Integral stimulation – patient listens and watches SLP as she makes sound/word then patient imitates while SLP simultaneous produces target.
- Same as step 1 but patient’s response is delayed and the clinician mimes the response without sound during the patient’s response.
- Integral stimulation followed by imitation without any simultaneous cues from clinician
- Integral stimulation with several successive productions without any intervening stimuli and without simultaneous cues.
- Written stimuli are presented without auditory or visual cues, followed by patient production while looking at written stimuli.
- Written stimuli, with delayed production following removal of written stimuli. (count 10 seconds).
- Response elicited by question, “What do you drink your coffee in?”
- Response target produced in role play situation.
Sound Production Treatment (SPT)-Wambaugh
– uses minimal contrasts (bye-pie) to aid in refining movement patterns that differentiate sounds. Works in hierarchy similar to the 8-step plan from Rosenbek’s Eight Step Continuum
Biofeedback to treat apraxia of speech:
o May be useful in addition to other therapies but not by itself.
o EMG feedback may help to for muscle relaxation.
o Electromagnetic articulography provides visual feedback about tongue positions
(not very common)
Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPTS):
– developed for children with AOS but now used also with severe adults.
o Tactile-kinesthetic input – highly structured finger placement on patients face and neck tell the articulatory placement.
o Usually used with severe AOS with very limited verbal output
Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPTS):
– developed for children with AOS but now used also with adults.
o Tactile-kinesthetic input – highly structured finger placement on patients face and neck tell the articulatory placement.
o Usually used with severe AOS with very limited verbal output
Melodic Intonation Therapy (MIT) for apraxia of speech:
o Developed for nonfluent aphasia.
o Not everyone is candidate for MIT – must have good verbal comprehension, limited spontaneous verbal output, good self-monitoring. Example of good candidate – Broca’s aphasic with oral apraxia and AOS.
o MIT begins with hand-tapping rhythms, then going to simultaneous humming with clinician, addition of words, phrases, and gradual fading of model.
o Doesn’t use familiar tunes but emphasizes exaggerated pitch, tempo and rhythm.
o Eventually modified to spoken song, then speech.
o Success due to pulling in the right brain
Biofeedback to treat apraxia of speech:
o May be useful in addition to other therapies but not by itself.
o EMG feedback may help to for muscle relaxation.
o Electromagnetic articulography provides visual feedback about tongue positions
Multiple Input Phoneme Therapy (MIPT):
Identify most frequently occurring stereotype (such as go-go) and use this as target of treatment (6)
- Clinician produces target many times emphasizing initial phoneme, patient taps simultaneously.
- Patient then joins in with the repetitions
- Clinician fades voice but mouths utterance and taps as patient says target.
- Repeat these steps for other stereotypical utterances. The idea is to say these stereotypical utterances voluntarily.
- Then work on new words with the same initial phoneme as the stereotypical utterance.
- Targets then broadened to include all phonemes
