Acquired Apraxia of Speech

Acquired Apraxia of Speech

Apraxia of speech (AOS) is a "neurologic speech disorder that reflects an impaired capacity to plan or program sensorimotor commands necessary for directing movements that result in phonetically and prosodically normal speech"- ASHA.  AOS has also been referred to in the clinical literature as verbal apraxia or dyspraxia. 

AOS frequently co-occurs with dysarthria and/or aphasia and sometimes with limb apraxia, oral apraxia, apraxia of gait, and/or apraxia of swallowing. AOS does not directly involve muscle weakness, paralysis, spasticity, or involuntary movements typically associated with dysarthria, or language comprehension or production deficits that characterize aphasia.

Apraxia In Adults

The salient features of AOS might include:

• Reduced overall speech rate

• Phoneme distortions and distorted substitutions, additions, or complications

• Syllable segregation with extended intra- and inter-segmental durations

• Equal stress across adjacent syllables.

These features are consistent with deficits in the planning and programming of movements for speech and are noted to increase with greater syllable length and motoric complexity.

AOS can improve over time (e.g., in acute stages of stroke recovery, in response to therapy), remain stable, or worsen overtime (e.g., primary progressive apraxia of speech).

Other Perceptual Speech Characteristics

The following other speech characteristics may not be unique to AOS and can also occur with co-existing dysarthria or aphasia.

Articulation

• Consonant errors greater than vowel errors

• Voicing errors (blurred distinctions between boundaries of voiced–voiceless consonants)

• Prolonged phonemes

• Telescoping of syllables (e.g., "disaur" instead of "dinosaur")

Rate and Prosody

• Slow overall rate, regardless of accuracy of productions

• Alternative motion rates (AMRs) that may be characterized by place or manner errors

• Poorly sequenced sequential motor rates (SMRs)

Fluency

• Disrupted fluency with attempts at self-correction

• Difficulty initiating articulatory sequences—may be accompanied by audible or silent groping behaviors marking false starts and restarts

• Sound and syllable repetitions

Other Problems That Can Co-Occur With AOS

Linguistic and non-speech/non-orometer features that are observed during clinical presentation typically depend on the site of lesion and comorbid conditions. These comorbid conditions may include the following:

• Aphasia—language comprehension and/or production deficits

• Dysarthria—motor speech disorder characterized by impaired neuromuscular speech movements due to weakness or paralysis, spasticity, incoordination, involuntary movements, or reduced movement range

• Nonverbal oral apraxia—difficulty programming orofacial musculature for non-speech movements

• Apraxia of swallowing—difficulty programming muscles of the head and/or neck for coordinated swallowing

• Limb apraxia—difficulty programming purposeful limb movements, often of both extremities

• Varying degrees of right-sided weakness and spasticity

Goal of Intention

The goal of intervention is to help the patient achieve the highest level of independent function for participation in daily living. Intervention is designed to:

• Capitalize on strengths and address weaknesses related to underlying structures and functions that affect communication

• Facilitate the individual's activities and participation toward the acquisition of new skills and strategies

• Modify contextual factors that serve as barriers and enhance those factors that facilitate successful communication and participation, including development and use of appropriate accommodations

For patients with AOS, treatment goals focus on facilitating the efficiency, effectiveness, and naturalness of communication by:

• Improving speech production and intelligibility

• Using augmentative and alternative forms of communication (AAC), such as gestures, manual signs, electronic speech output devices, and context-specific communication boards.

Barriers to successful communication and participation can be minimized for individuals with AOS by:

• Modifying the environment (e.g., reducing background noise, maintaining eye contact, and decreasing the distance between speaker and listener)

• Informing listeners about the individual's communication needs and his or her preferred method of communication when indicated

• Encouraging the speaker to use strategies for repairing breakdowns in communication (e.g., repeating, rephrasing, using gestures, writing).

Apraxia Treatment Options

Treatment Options

Below are treatment options for addressing AOS, grouped by approach. This list is not exhaustive.

Articulatory–Kinematic Approaches

• Multiple Input Phoneme Therapy (MIPT)

• Script Training

• Sound Production Treatment (SPT)

• Speech Motor Learning (SML) Approach

Sensory Cueing Approaches

• Integral Stimulation (IS)

• Tactile Cueing

• Visual Cueing

Rate and Rhythm Control Approaches

• Contrastive Stress

• Melodic Intonation Therapy (MIT)

• Metrical Pacing Treatment (MPT)

• Rhythmic Pacing

Augmentative and Alternative Communication (AAC)

See section on Augmentative and Alternative Communication (Under Communication Category)

Please call (702) 979-4268 for more information

Providing The Means To Achieve