CSD 550 Final

impairment of the ability to perform preplanned volitional purposeful movements in absence of paralysis or weakness, sensory loss, comprehension deficit or ataxia

apraxia

misalignment on page, spatial disorientation is apart of which apraxia?

constructional apraxia

this apraxia is often found with right parietal lobe lesions

constructional apraxia

__________ is one of the biggest contributors to what we see in apraxia

stroke

Desired response may be absent; person may produce haphazard, unrelated movements to get from point a to point b

response

Appropriate movements of two or more gestures may be combined into one

response

Desired ___________ may be accurately completed after several groping gestures

response

Inability to perform visuospatial tasks such as drawing, assembling stick designs, and constructional three dimensional block arrangements

constructional apraxia

which apraxia affects writing?

constructional

Semiautomatic motor ability for dressing oneself is lost

dressing apraxia

Unable to organize the gestures necessary to establish the appropriate relationship between clothes and the body

dressing apraxia

which apraxia is related to visuospatial difficulties in the
right hemisphere
?

dressing apraxia

Inability to carry out facial movements to verbal command
-Commonly seen with left hemisphere/anterior region damage

oral apraxia

this apraxia is commonly seen with
left hemisphere/anterior region damage

oral apraxia

relationship of oral speech to apraxia is __________

unclear

Absence of spontaneous activity of the unimpaired side

unilateral limb apraxia

unilateral limb apraxia is also know as:

sympathetic apraxia

abnormal movements and impairment of activities that require coordination of both hands

unilateral limb apraxia

this apraxia is associated with right hemiplegia and motor aphasia

unilateral limb apraxia

Gestures performed by left arm and leg were severely impaired to command and imitation

unilateral limb apraxia

Apraxia of whole-body movements such as lying down, sitting, standing up or rolling over

whole body apraxia

gait disorder and preservation of whole body movement is seen in which apraxia?

whole body

Correctness of individual elements of a complex act without accomplishing the desired objective

ideational apraxia

the patient fails to apply the elements to a purpose/plan

ideational apraxia

Normal sequence of the overall act may be altered, resulting in inaccurate and sometimes bizarre performances (one action may be substituted for another, steps may be omitted, and preservation of one action into another is common)

ideational apraxia

Isolated gestures are impaired, but the overall purpose may be preserved

ideomotor apraxia

In ideomotor apraxia, the patient may be have difficulty performing volitional acts with the nonparalyzed hand, although performance of ____________________ with the same hand is not impaired

automatic movements

In ideomotor apraxia, disorder rarely presents itself during ________________ and is often detected by tests of ___________________________

-spontaneous activity
-verbal
command/imitation

this apraxia is associated with parietal and temporal lesions

ideomotor apraxia

n articulatory disorder resulting from impairment, due to brain damage of the capacity to program the positioning of speech musculature for the volitional production of phonemes and the sequencing of muscle movements for the production of word

apraxia of speech

a pathology in the left cerebral hemisphere results in which aparaxia?

apraxia of speech

individuals with _____________ apraxia experience:
-numerous phonemic errors, including substitutions, omissions, additions, repetitions, and distortions with a predominance of substitutions in the absence of significant weakness
-slowness or incoordinati

apraxia of speech

_________ errors are more common than manner, voicing or oral-nasal in apraxia of speech

place

which sounds are often correct in apraxia of speech?

alveolar and bilabial

marked prosodic disturbance without phonatory and resonators changes include:

-equal and even stress
-insert inappropriate inter syllabic pauses
-restriction and alteration of normal intonational contours
-normal durational relationships of vowels and consonants are distorted
-rate of production is slowed overall

apraxia battery for adults- dabul

-diadochokinetic rate
-increasing word length
-limb and oral apraxia
-latency and utterance time for polysyllabic words
-repeated trials
-inventory of articulation characteristics of AOS

basic goals of treatment for apraxia

-improve motor planning
-consider linguistic difficulties
-easy and simple articulatory positioning
-rassure patient that their musculature is all right because they are able to cough, laugh, etc.

generally, __________ planning is the primary impairment in apraxia, so use a _______ approach to therapy

motor
motor

the secondary impairment in apraxia is _______________ impairment, so use a _________________ approach

linguistic

Motor approaches are based on a _______________ of stimuli
-They require _____________ and __________
-Include methods such as: ____________. _________________, and _____________

-hierarchy
-repetitive practice and drill
-articulatory methods
-gestural methods
-prosodic methods

articulatory methods for motor approaches are a ________________ sequence and include __________, ________________, and ____________

-bottom up
-integral stimulation
-multiple phoneme therapy
-PROMPTS

what method is used with moderate to severe apraxia of speech?

-articulatory methods: integral stimulation

in this method, you tell the client to watch you and listen to you, then model the stimulus

articulatory methods: integral stimulation

clinician chooses set of utterances w/ client that are meaningful to client; begins at max or high cueing and slowly fade cueing as client improves

integral stimulaiton- eight step continuum

Checks for patient's ability to discriminate productions of phonemic error

phonetic placement Tx

use ___________________ with severe apraxia

multiple input phoneme therapy (MIPT)

a dynamic tactile-kinesthetic, oral-facial cueing system

PROMPT

Hierarchically structured program that is divided into 3 levels.

melodic intonation therapy

First 2 levels of MIT use

multisyllabic words/phrases that are musically intoned

3rd level of MIT uses:

1. longer or more phonologically complex sentences
2.first intoned
3. then produced with exaggerated speech prosody
4. then finally spoken normally

a good candidate for MIT has had a _____________ stroke near broca's area

unilateral, left-hemisphere

Based on the principle of intersystemic reorganization: the use of hand/limb gestures to facilitate movement for speech production

motor approaches: gestural methods

should you use gestural methods instead of speech production based treatment when prognosis for developing speech is good?

no

can you use gestural methods in conjunction with speech production focused therapy?

yes

AMERIND is a _________ method based on native american sign language

gestural

what is the primary goal of dysarthria speakers?

intelligibility

goal for mild apraxia is:

speech naturalness

goal for moderate apraxia is:

speech intelligibility

goal for severe apraxia is:

communication with AT/AAC

sustained /ah/ should not be louder than:

90dB SPL @ 30 cm

can you change LSVT functional phrases?

no

goal may not be normal speech production

goal- reduce impairment

Modify speech production to maximize use of remaining skills (may work on strengthening in LMN and relaxation in UMN)
-Can be behavioral or prosthetic

goal- compensation

Reorganization of environment so that functions which were lost are not required to interact
-Plan for the progressive loss of speech in degenerative disorders (AAC)
-Maximize communication so less adjustment is required

goal- adjust

Usually directed at relieving symptoms
-Know the drugs the client is taking and for what
-Begin other therapy when the effects are stable
-Be aware of the cycling of the effects

pharmacological management

-Palatal lift prosthesis
-Amplification system
-AAC
-Pacing board
-Delayed auditory feedback and biofeedback devices

prosthetic management

Focus on changing the speaker behavior (improve function or compensations)

speaker-oriented
(behavioral management)

Focus on changing the behavior or listeners or the environment

communication-oriented (behavioral management)

-Reduce the use of behaviors which are not improving communication
-May be strategies which the individual is using to try to compensate for current difficulties speaking
-May be strategies that worked at an earlier stage of the disorder, but now impede c

maladaptive behaviors

What are two clinical measures of intelligibility?

1. Assessment of Intelligibility of Dysarthric Speech (AIDS)
2. Frenchay Dysarthria Assessment (glorified oral mech)

-Connected speech
-Speech-like-tasks
-Tasks that involve only one or two components (sustained phonation)
-Tasks that focus on a single component (ratings of breath)

task and measurement appraoches

problems with perceptual measures

Same symptoms may be the result of very different underlying conditions.

if loudness is appropriate, then respiratory is like to be:

okay

What should we use for the assessment of respiratory/phonatory function?

voice evaluation

Respiratory Functions for Speech

-loudness
-breathing pattern
-voice quality

All of the words said on one breath

breath group

Want to look at structure, range of motion (look for dyskinesias), strength, rate, coordination, accuracy of movement, and muscle tone

oral mechanism examination

Should medical treatment start before speech therapy?

Yes, because the medical treatment may change the goals of therapy.

Should we do therapy due to the presence of an impairment?

Not always... we have to base this decision on the amount of activity and participation restriction; we also might not be the first concern

What is the goal of dysarthria management?

-reduce impairment
-compensate
-adjust
we want to look at communication as a whole, not just speech

What should the goals be set at?

60-80% success rate

at first, focus on __________, then slow __________ if necessary

accuracy
speed

in early treatment, use______________ sessions __________ times a day

frequent short sessions
2

How should we plan our sessions?

-begin with easy task
-proceed to harder task
-end with success

Allows for more individualized management, can complete more practice trials, can alter activity based on response more quickly.

individual therapy

Allows for carry-over and natural practice, give an opportunity for the client to see techniques being employed, lets the client see s/he is not alone, allows for peer feedback.

group therapy

What are the stages of dysarthria consideration?

Stage 1: No functional speech (AAC)
-Stage 2: Speech supplemented (intelligibility poor)
-Stage 3: Reduced intelligibility (look for compensatory strategies)
-Stage 4: Obvious dysarthria
-Stage 5: No speech disorder

the best treatment candidates are those whose disease is _____________ and who speech is ___________ by the treatment

treatable
improved

2 foundations of treatment

neuroplasticity (motor planning)
drill (motor memory)

bracing, slings, girdling (used with hyperkinetic movement disorders)

posture treatment

-Support head
-Jaw elevation
-Bite Block (inhibits hyperkinetic/tremor movement

posture for articulation treatment

-Progressive muscle relation
-Jaw shaking
-Chewing

muscle tone treatment

-Palatal Massage
-Visual Feedback
-Auditory feedback

Resonance Dysarthria Treatment

-Phonetic-
placement (voice, place, manner)
-Contrast drills

Articulation Dysarthria Treatment

-Postural Adjustments
-Prosthetic Assistance
-Speech Tasks -biofeedback/modifications of breathing patterns

respiratory management

Physical strategies to enhance adduction (effort closure techniques, posture adjustments, physical manipulations)
*LSVT Treatment

Hypoadduction Management (phonatory system)

-Nonspeech tasks
-Biofeedback
-Behavioral (volume levels/rotate head)
-Speech Tasks
-Relaxation strategies (spastic and hyperkinetic)

Hyperadduction Management (phonatory system)

botox injections are good for:

hyperadduction

what can you do to improve velopharyngeal impairment?

-prosthetics
-surgery
-exercise

Used most with TBI, cerebrovascular accident, and cerebral palsy

prosthetic management

-props up soft palate
-provides mechanical impedance to air attempting to enter the nasal cavity

palatal lift flaccid dysarthria

Used as a speech enhancing prosthesis by occluding the nares and decreasing nasal airflow for patients with VP insufficiency and VP incompetence

nasal obturator

Activity for inadequate breath support to speak long phrases in Flaccid dysarthria:

teach them to make phrases shorter

Activity for hypernasality in Spastic dysarthria:

have the patient open their mouth really wide when they speak

activity for uncoordinated speech movements in Ataxic dysarthria:

Work on articulation, starting with words and moving through phrases and sentences

Activity for short rushes of speech in Hypokinetic dysarthria

Teach the client to slow down their speech rate by chunking phrases to create natural pauses.

Activity for harsh voice in Hyperkinetic dysarthria

Symptoms are generally treated with medicine

Activity for inappropriate rate in Apraxia dysarthria

Teach the client to slow down their speech rate by chunking phrases to create natural pauses.

think loud for:

speech and improving loudness

think big for:

PT & OT- focus on bigger movements of body

should you use sign language if there are no individuals in the client's environment who will use it with them?

no

Uses prosodic cues and stress patterns to facilitate speech production and prosody

prosodic methods: contrastive stess

motor approaches: prosodic methods include

melodic intonation therapy
contrastive stress

you should only use prosodic methods if the individual has demonstrated _____________ skill for the ________________

articulatory
target phonetic string

in apraxia of speech, errors may be:

metathetic

error sounds in apraxia of speech are likely to vary from target by only:

1 phonetic dimension

consonant clusters are _____________

most difficult

are fricatives and affricates easy or hard?

hard

audible and visible groping movement of the articulators is key in:

apraxia of speech

T or F?: anticipatory errors are most common

true

as we increase word length, more __________ arise

problems

T/F?: you need both auditory and visual modalities to elicit most success

true

integral stimulation is where you sit side by side and look in mirror with client- a lot of imitation

...

MIPT is used to __________ down

slow rate of speech

Southwood treatment is used to __________ down

slow rate of speech

Square treatment uses:

PROMT

expectations for every patient should be ______________ in _________ sessions

-conversational speech
-16

speech no louder than

80-85dB SPL @ 30 cm

apraxia has numerous phonemic errors including: ___________ ___________ ______________ _________________ ________________

-substitutions
-omissions
-additions
-repetitions
-distortions

apraxia of speech has a _______________ of ________________ in the absence of ______________________, ________________, or _________________ of speech musculature

predominance
substitutions
weakness
slowness
incoordination

____________ movement of the articulators is common in apraxia of speech

groping

when the word length increases, what also increases?

number of phonemic errors

goal for LSVT

loud and good voice quality

aphasia is _____________ problems

word finding

can apraxia be aphasia?

yes

without aphasia, one does not have:

word finding problems

dysarthrics have trouble __________ while apraxics have trouble ___________

executing
planning

T/F?: strengthening artic and phonation muscles is the primary Tx for spastic dysarthria

false

T/F?: the primary treatment for hyperkinetic dysarthria is artic therapy

false

for sustained "ah" and high/low "ah", whats the best therapy to do ?

model, biofeedback, voice quality

a lady used a pencil the wrong way to write; which apraxia is this?

ideational

smiling is associated with which cranial nerve?

facial

daily tasks for LSVT

-maximum duration of sustained vowel phonation
-use loud voice in real life situations

apraxic speech is island free of speech error

true

Common positive outcomes of prosthetic management

-Improved articulation
-Improved speech intelligibility -Decreased hypernasality
-More efficient respiration for speech