SPH528 - Apraxia of Speech

Question 1

List 4 main approaches to AOS (Wambaugh et al. 2006)

Answer 1

1. Articulatory Kinematic
2. Rate and/or rhythm
3. AAC
4. Intersystemic facilitation/reorganistion

Question 2

Articulatory Kinematic approaches assume that AoS reflects disruption to the spatial and temporal aspects of speech planning, so it focuses on reteaching people to articulate and sequence (reteaching articulatory gestures). What does it involve?

Answer 2

• Motoric practice of speech targets – LOTS of drill! (uses Principles of Motor Learning, Maas et al, 2008)
• Modelling of targets (integral stimulation approach often used)
• Specific feedback on Performance

Question 3

What does the ‘integral stimulation’ approach use?

Answer 3

• Watch me
• Listen to me
• Say it with me
• Say it again (on your own)

Question 4

Articulatory Kinematic approaches use a lot of articulatory cueing. What kind of articulatory cues might be used?

Answer 4

*Diagrams (of articulators, etc)
*Videos
*Verbal instructions
*Written cues
*Photos/pictures
 these help people get the articulators in the right place to make the target sound/word…

Question 5

What is the: Sound Production Treatment Hierarchy (Wambaugh et al, 1998)?

[targets: choose sounds relevant to the client, that they are having the most difficulty with  visible sounds (labials) are good to start with, to build confidence. Repeat the steps as many times as needed].

**Better to work on more than one sound at once to avoid the patient getting stuck on a posture.

Answer 5

An articulatory kinematic treatment

1. Modelling/imitation
2. Modelling + visual cue/imitation (ie model while SLP points to written letter/word and speaker repeats
3. Integral stimulation (if error in step 2) “Watch me, listen to me, and say it with me”
4. Modelling with silen juncture/imitation (if error on step 3) separating the target sound from the rest of the word z….ip
5. Articulatory placement/modelling (if error in step 4, SLP to give verbal instruction on articulatory placement.

Question 6

What is PROMPT?

Answer 6

An Articulatory Kinematic Treatment  Prompts for Restructuring Oral and Muscular Phonetic Targets (PROMPT)

• Provides auditory, visual, and tactile-kinaesthetic stimulation
• Aims to cue correct MOA and POA

Question 7

Although articulatory kinematic approaches to intervention for people with AoS do show improvements in articulatory function and perceptual measures (including intelligibility), how does this translate to real lfe?

Answer 7

Little changes at participation level, despite improvements  getting good functional gains is challenging.

• Generalisation - trained sounds may generalise to other words… BUT
• Level of treatment – targeting words/phrases/sentences show gains but ONLY IN TREATED TARGETS.
• **SELECT STIMULI CAREFULLY (functional words/phrases/sentences)

Question 8

What are Rate and/or Rhythm Approaches to AoS treatment?

Answer 8

2nd most popular approach

• Assumes AoS is more general disruption to the timing of speech production (as opposed to disruption of planning sounds in combination)
• Often begins by adding an external pacing device

Question 9

What is Melodic Intonation Therapy (MIT)?

Answer 9

A Rate/Rhythm approach to AoS treatment

• Exploits rate and rhythmical properties of speech to facilitate speech production (and word retrieval)
• Exaggerates melodic line of speech -> moves towards more naturalistic approach

Question 10

Intersystemic facilitation / reorganisation approaches to AoS treatment?

Answer 10

*Aims to take a relatively intact system, to facilitate one that is impaired (Wambaugh et al, 2006)  add in gestural cues (afferent and efferent) to support speech production

Question 11

Main problems with outcomes for treatment of AoS?

• Regular, careful data collection to ensure treatment is supporting goals.

Answer 11

• Generalisation
• Improvement in speaker participation levels

*Prognosis: for many people with AOS, issues with speech are likely to be ongoing -> AAC can help a lot! -> can also be used in acute phase and phased out if appropriate

Question 12

Positive outcomes shown for AAC use in people with AOS?

Answer 12

*Speech – really!
*Communicative success
*Initiating communication
*Acquisition of symbols
Psychosocial well-being
- initial focus on acceptance of AAC probably needed before implementation -> offer it early and add it into therapy approaches that are used

Question 13

Given the stronger evidence base, should an articulatory kinematic approach to AOS intervention be the ‘default’ treatment?

Answer 13

NO! -> Good for moderate-severe AOS. BUT rate/rhythm approaches, intersystemic treatments and AAC approaches should also be considered, as some patients may respond better to these -> consider the individual.

Question 14

Targets for intervention for dyspraxia: Restore

Answer 14

• Automatic speech, singing -> speech
• Trigger phrases
• Integral stimulation

Question 15

Targets for intervention for dyspraxia: Compensate

Answer 15

• Speaker, listener and environmental strategies

* Augmentative communication

Question 16

Targets for intervention for dyspraxia: Substitute

Answer 16

• Alternative communication

* Different life roles and activities