Apraxia of Speech

1
Apraxia of Speech Dysphagia Disorders
2
Apraxia of Speech

• An articulation disorder resulting from brain
  damage that caused difficulty sequencing the
  muscle movements for volitional speech

3
Neurobases of speech apraxia

• Damage to left frontal lobe
• Brocas area
• Often co-occurs with Brocas aphasia
• Often co-occurs with UUMN dysarthria

4
Etiologies of speech apraxia

• CVA 58 of apraxia of speech
• Perisylvian area
• Degenerative disease
• Traumatic brain injury
• Tumors
• Seizure disorders

5
Speech characteristics

• Articulation errors
• Inconsistent errors
• Substitution errors of placement most common
• Anticipatory errors
• Perseverative errors
• Metathetic (transposition) errors
• Longer sequences of sounds cause more
  articulation errors
• Voluntary speech more affected than automatic
• Prosody errors
• Slow rate
• Equal stress
• Monopitch

6
Differential diagnosis

• Must rule out other causes
• No muscle weakness
• No comprehension deficit
• No coordination issues
• Key evaluation tasks
• Compare SMR to AMR
• Get conversation to assess prosody
• Compare varying utterance lengths
• ABA

7
Treatment

• General procedures
• Progress is slow
• Intensive, repetitive drill
• Controlled sequencing of phonemes
• Functional speech is the goal
• Specific programs
• PROMPT and MIT for more severe cases
• Rosenbeks 8 step continuum for more mild cases
• Darley, Aronson and Brown

8
Rosenbecks 8 step continuum

• Clinician presents verbal stimulation (watch me
  listen to me). Clinician/client produce target
  utterance in unison.
• Clinician presents stimulation with visual cue
  only (e.g. mouths utterance without sound) while
  client produces the target aloud.
• Clinician presents stimuli
• 4. Repeat step 3, but requires target to be
  produced several times in a row without
  additional model.
• 5. Clinician presents written stimuli, which
  client reads aloud
• Clinician presents written stimuli, removes the
  stimulus, client produces target
• Clinician presents a question designed to elicit
  target utterance and client responds
• 8. Clinician engages in role-play situations to
  elicit target utterance.

9
Sample of Rosenbecks program

• 1. Watch and listen, Salt and pepper. Say with
  me, Salt and pepper.
• 2. Listen, Salt and pepper. Say, (clinician
  moves lips only).
• 3. Say, Salt and pepper. Client repeats.
• 4. Say, Salt and pepper 3 times. Client does.
• 5. Present card SALT AND PEPPER. Client reads
  aloud.
• 6. Present card, remove it. Ask, What did it
  say?
• 7. Ask, What spices do you put on your baked
  potato?
• 8. Role-play a dinner scene in which you would
  ask someone to pass the salt and pepper.

10
Dysphagia

• Disorder in swallowing that can affect one of
  four stages of the normal swallow
• Preparatory phase
• Oral phase
• Pharyngeal phase
• Esophageal phase

11
Treatment for Dysphagia

• Preparatory or oral phase difficulties feeding
  techniques
• Pharyngeal phase difficulties swallowing
  therapy

12
Feeding Techniques

• Modifying food consistency or texture
• Adjusting amount of food presented
• Adjusting the rate of food presentation
• Increasing sensory awareness

13
Swallow therapies

• Changing head and/or body posture
• Modifying swallow movements
• Supraglottic swallow
• Super-supraglottic swallow
• Effortful swallow
• Mendelsohn maneuver