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Transcript of Adult Apraxia
By Zeina M. Geha
What is Adult Apraxia?
Apraxia is an acquired motor speech disorder caused by damage to areas of the brain that are responsible for modulating speech
It can be caused by:
People with apraxia of speech know what words they want to say, but their brains have difficulty coordinating the muscle movements necessary to say those words.
Definition of Apraxia
Speech Language Issues
Goals of Treatment
Difficulty imitating speech sounds
Slow Rate of Speech
Prolonged durations of sounds
Consistent errors within an utterance
Difficulties initiating speech
Speech Language Issues
Damage to the parts of the brain that are involved in speaking.
Involves the loss or impairment of existing speech abilities.
May occur together with muscle weakness affecting speech production (dysarthria) or language difficulties caused by damage to the nervous system (aphasia).
There is not a single test or procedure that is used to diagnose apraxia of speech.
Primary Diagnosis Measures include:
Listening to a patient's speech
Observing oral motor movements
Looking for apraxia symptoms
Assessing a patient's ability to repeat a word multiple times.
A differential diagnosis must be used in order to rule out other similar or alternative disorders. The disorders must be distinguished in order to correctly treat the patients.
Diagnostic imaging tests such as magnetic resonance imaging may be used to help distinguish acquired apraxia from other communication disorders that are caused by brain damage.
Improve verbal skills
Decreasing the tension and struggle
Working to decrease word or situation avoidance
Improve clarity and pace of speech
Wambaugh, J., Duffy, J., McNeil, M., Robin, D., Rogers, M. Treatment Guidelines for Acquired Apraxia of Speech: A Synthesis and Evaluation of the Evidence. Journal of Medical Speech-Language Pathology. Volume 14, Number 2, pp. xv-xxxiii. Copyright © 2006 Thomson Delmar Learning. Thomson and Delmar Learning are trademarks used herein under license. http://www.ancds.org/pdf/articles/Wambaugh-AOS_Tx_evidence-2006.pdf
Keith A. Josephs et al Characterizing a neurodegenerative syndrome: primary progressive apraxia of speech. Brain 2012 135: 1522-1536.
Turkstra, L., Ylvisaker, M., Coelho, C. (2005). The use of standardized tests for individuals with cognitive-communication disorders. Seminars in Speech & Language. 26(4):215-22
William O. Haynes, Michael Moran, Rebekah Pindzola. Communication Disorders in Educational and Medical Settings. An Introduction for Speech Language Pathologist, Educators and Health Professionals. Sudbury MA: Jones and Barlette Learning. 2012. Print
Dworkin, J. P., Abkarian, G. G., & Johns, D. F. (1988). Apraxia of speech: The effectiveness of a treatment regime. Journal of Speech and Hearing Disorders, 53, 280–294.
Uses auditory, visual, written and physical cues to promote speech
Alternative and augmentative communication device (AAC)
It is a device that supplements and promotes speech
Unaided devices are those that do not require an external tool, and include facial expression, vocalizations, gestures, and sign languages and systems.
Aided devices include pictures, letters and words.
8 Step Continuum
Craig is an author who suffered from a stroke and underwent speech therapy for apraxia, a common complication of a stroke.
Notice these characteristics in Craig
Rate and Rhythm Control
This method involves manipulation of rate and/or rhythm to improve speech production or reduce symptoms of AOS
Paces the speech by utilizing hand tapping, interactive metronome and imitation.
Also involves slowing the rate of speech production in speakers who already exhibit a reduced production rate
Acquired apraxia results from brain damage to those areas of the brain that control the ability to speak. This can occur in patients at any age and has an immense impact of their quality of life.
The current treatment options have proven to be effective and offer patients a chance at getting their life back on track.
Ongoing research on acquired apraxia of speech includes studies to pinpoint the specific areas of the brain that are involved in the disorder and this will aid in finding improved treatment strategies.
Uses vision and manual limb gestures to re-access speech production
Gestural reorganization, pairing speech with limb gesturesprovides an organizational framework for the proper sequencing of motor speech movements
Constraint Induced Therapy
Improves speech by using only verbal output to promote speech
Step 1: Integral stimulation- the therapist asks the patient to look and listen and imitate sound produced, first in unison
Step 2: The therapist performs integral stimulation but this time asks the patient to delay the response. The therapist silently mouths the correct production while the patient produces it verbally
Step 3: The therapist performs integral stimulation then asks the client to imitate without any cues
Step 4: Integral stimulation is performed with several successive productions without simultaneous cues
Step 5: Printed stimuli are presented by the therapist without any auditory or visual cues. The patient is then asked to say the printed stimuli.
Step 6: Written stimuli is presented to the patient. The patient is then asked to produce it after its removal.
Step 7: The therapist elicits a response by asking a question
Step 8: Role playing is used to elicit responses