Managing Apraxia of Speech Flashcards
What should the clinician work on first, language or speech if a patient is diagnosed with aphasia and apraxia?
It may be best to work on the language problems first before working on apraxia.
Why is it difficult to determine sometimes if the error is due to apraxic problems or aphasia?
Aphasia very often co-occurs and influences treatment because it affects a person’s ability to understand oral directions and their verbal expressions.
What kind of medical treatment is available for patients with apraxia?
Medications are not used for apraxia nor injections.
Why are prosthetic devices such as palatal lift not necessary for patients with apraxia?
Hypernasality is not typically a severe problem in AOS. There can be exceptions.
What can be helpful to reduce rate of speech in patients with apraxia?
Pacing devices such as pacing boards, metronome, and finger tapping.
_________ has not typically been beneficial for patients with apraxia and has been disruptive to speech in patients with co-existing Broca’s aphasia.
Direct auditory feedback
AAC aids such as ____ _____ may help patients with apraxia.
letter boards
What do all behavioral management approaches emphasize for patients with apraxia?
- careful selection of stimuli
- orderly progression of treatment items
- intensive and systematic drill
What are the principles of motor learning?
- Drill, drill, drill
- patients need to develop self-monitoring and self-correction skills early
- Listen and watch me approach
- Use automatic speech to begin with
- Feedback is helpful
- Use speech tasks if possible
- Intensive practice/therapy
- Begin with consistent practice, then move to variable
- reduce rate to improve accuracy
What is involved in the drill, drill, drill principle of motor learning?
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.
What approach is helpful to a person who has to begin at the sound, syllable, or word level?
Listen and watch me approach: 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.
How does automatic speech approach help patients with apraxia at the beginning?
It helps provide success
What are examples of automatic speech tasks?
Have them count, say days of the week.
Why is it helpful to have patient use a mirror for feedback?
To develop strong visual image of correct movement
What should a clinician focus on with a patient who is mute?
Focus on vegetative actions such as coughing, laughing, humming, and singing.
What should a clinician focus on when the patient has severe apraxia?
Focus on sound, syllable or non-speech tasks.
Use ____ tasks if possible. ________ tasks have not been found to be helpful unless the patient cannot make syllables or sounds.
speech
non-speech
What is inolved in intensive practice/therapy?
Use multiple repetition of stimuli
Explain the consistent practice and variable practice.
Do 10 reps of stress on one syllable, then 10-reps of stress on another syllable for consistent practice, then vary conditions.
Reduce _____ to improve accuracy. Once articulation is accurate then try to return no normal ______.
rate
rate
What is Rosenbek’s Eight step continuum? Articulatory kinematic Approach
- 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 to 10 seconds)
- Response elicited by question, “what do you drink your coffee in?”
- Response target produced in role play situation.
What is sound production treatment (SPT)- Wambugh
Uses minimal contrasts (bye-pie) to aid in refining movement patterns that differentiate sounds. Works in hierarchy similar to the Rosenbek’s eight step plan.
What is Prompts for restructuring oral muscular phonetic targets (PROMPTS)?
- Tactile-kinesthetic input - highly structured finger placement on patients face and neck tell the articulatory placement.
- usually used with severe AOS with very limited verbal output.
PROMTS is usually used with what population?
Usually used with severe AOS with very limited verbal output
What types of patients was melodic intonation therapy developed for?
Patients with non-fluent aphasia
Who is a good candidate for melodic intonation therapy (MIT)?
Must have good verbal comprehension, limited spontaneous verbal output, and good self-monitoring.
Provide a good candidate for MIT.
Broca’s aphasic with oral apraxia and AOS.
Describe MIT.
It begins with hand-tapping rhythms, then going to simultaneous humming with clinician, addition of words, phrases, and gradual fading of model.
MIT doesn’t use _____ ______ but emphasizes exaggerated ____, ____, and ______.
familiar tunes
pitch
tempo
rhythm
What does MIT emphasize?
pitch, tempo, and rhythm
What is MIT eventually modified to?
spoken song and then speech
Why is MIT successful?
Success due to pulling in the right brain
________ may be useful in addition to other therapies but not by itself.
Biofeedback
______ feedback may help for muscle relaxation.
EMG
What does electromagnetic articulography provide?
Visual feedback about tongue positions.
_________ _________ provides visual feedback about tongue positions.
Electromagnetic articulography
List Severe apraxia (speechless) techniques:
- use automatic speech tasks
- use carrier phrases
- singing familiar songs, happy birthday, jingle bells
- Pair symbolic gestures with assoicated sound/word. This may help to elicit word.
What techniques can be used for problems with initiating phonation?
Try yawning, sighing, coughing, and shaping phonation from there. Put clinician’s hand on larynx and slightly depress-ask patient to say “ah” push in slightly on abdomen with patients mouth open to elicit vocal fold closure and possible phonation.
how does pairing symbolic gestures with associated sound/word help?
This may help elicit word.
List techniques for sound, syllable, and word level:
- For problems initiating phonation: Try yawning, sighing, coughing, and shaping phonation from there. Put clinician’s hand on larynx and slightly depress-ask patient to say “ah” push in slightly on abdomen with patients mouth open to elicit vocal fold closure and possible phonation.
- may help to work on nonsense words rather than words with meaning.
- work on isolated sounds then shape into words, hum then prolong this to “ma” then add final consonant so you have a CVC.
- Cueing strategies are helpful especially phonetic placement cues.
What type of patients benefit from multiple input phoneme therapy (MIPT)?
Used with severely aphasic and apraxic patients whose repetition abilities are impaired and who have frequent stereotypical words/phrases.
What does MIPT aid in patients with apraxia?
May aid in reducing struggle to speak voluntarily.
What are the steps for multiple input phoneme therapy (MIPT)?
- Identify most frequently occurring stereotype (such as go-go) and use this as target of treatment.
- 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 utterance voluntarily.
- Then work on new words with the same initial phoneme as the stereotypical utterance.
- Targets then broadened to include all phonemes
What is voluntary control of involuntary utterances (VCIU)?
Similar to MIPT but relies on written as well as verbal input.
List techniques for multiple syllable level:
- Focus on rhythm, stress and intonation while concurrently working on articulation
- Use phonetic contrasts, bye-pie sing sting, to chew
______ _______ ________-use words correctly produced to gain control over speech by answering questions with the word, read the word, etc. Then use the initial sound of this word to lead into another word.
Key word technique
List rate and rhythm approaches for patients with arpaxia:
- Work on rate modification via pacing board, letter board, finger tapping, metronome
- Finger counting- hold up one finger for each word uttered.
- Prolonging vowel and stretching out words
- singing familiar songs, happy birthday
- melodic intonation
Describe script training:
Limited number of words/phrases learned and practiced in specific scripts. Used for moderately severe aphasia with AOS.
View Youtube video “Breaking through aphasia and apraxia”
Core sentence technique (Let’s talk program)
Youtube video “apraxia 1”
oral and verbal apraxia
View youtube PROMPT therapy for apraxia video
PROMT
View youtube video for sounrd production treatment video
Sound production treatment for apraxia
What is the primary goal for treatment of people with apraxia?
To maximize the effectiveness, efficiency, and naturalness of communication.
What does treatment for patients with apraxia focuses on?
Treatment focuses on restoring or compensating for impaired function and adjusting to the loss of normal speech.
How does treatment of dysarthria differentiate from treatment of apraxia?
Treatment of dysarthria focuses on physiologic support for speech whereas for apraxia treatment focuses on improving the programming of speech.
Apraxia treatment should allow time for learning to be______. Dont’ stop treatment as soon as _____ is seen.
solidified
improvement
What should the goal for people with a progressive disease be?
The goal should not be to work toward improvement but to maximize communication.
Traditionally SLP’s started with targets that were ______.
stimulable
What has research shown about working on more difficult targets with clients who have apraxia?
May result in better generalization but will be harder to initially acquire,
