APRAXIA
Appalachian State University
Presented by Jennifer Downs and Lydia Lowke
November 12, 1997

 

I. Apraxia-an inability to perform volitional learned motor acts in the presence of normal comprehension, muscle strength, sensation, attention, and coordination. Results from a lesion disconnecting Broca’s area from the motor association area responsible for organizing intentional actions.

 

A. Ideational Apraxia- an inability to carry out a hierarchical complex motor plan as the result of bilateral cerebral injury (e.g., making a bed). The patient appears to have lost an overall concept of how to proceed to complete the motor task.

 

B. Ideomotor Apraxia-inability to perform previously learned motor acts. This is the most common type of apraxia. The patient fails to carry out a motor act to the examiner’s verbal command. Results from damage to the premotor area, motor strip, parietal, or temporal lobes in the dominant hemisphere.

 

1. Buccofacial-disturbance of the volitional movements of the tongue, jaw, and lips during non-speech tasks (e.g., whistling or drinking through a straw).

 

2. Limb- inability to carry out acts upon command. The patient is able to carryout motor acts spontaneously. Difficulty is not due to muscle weakness or comprehension deficits.

 

3. Constructional Apraxia-a deficit in which patients are unable to form a construction in space (e.g., the inability to copy a shape, complete block design, or match stick designs).

 

4. Apraxia of Speech-an impaired ability to execute voluntarily the appropriate movements for articulation of speech in the absence of paralysis, weakness, or incoordination of the speech musculature. Errors are inconsistent, involuntary speech is better than voluntary speech, errors include substitution, repetition, simplification, distortion, and addition. The errors increase with complexity and word length.

 

 

Rules We Have Lived By: Traditional Characteristics of Apraxia of Speech
After Darley, 1969.

 

Articulatory Characteristics in Apraxia of Speech
Quoted from Rosenbek and Wertz, 1976.

 

 Nonphonologic Influences on Articulation in Apraxia of Speech
 

II. Assessment-

a complete assessment would include an aphasia battery, oral mechanism exam, and an apraxia assessment.

Oral Apraxia Test

1. Open your mouth.

2. Stick out your tongue.

3. Blow.

4. Show me your teeth.

5. Pucker up your lips.

6. Touch your nose with your tongue.

7. Bite your lower lip.

8. Whistle.

9. Lick your lips.

10. Clear your throat.

11. Move your tongue in and out.

12. Click your teeth together.

13. Smile.

14. Click your tongue in top of mouth.

15. Chatter your teeth as if you were cold.

16. Touch your chin with your tongue.

17. Cough.

18. Puff out your cheeks.

19. Wiggle your tongue from side to side.

20. Hum.

 

III. Treatment for Apraxia of Speech-dependent upon severity of apraxia and accompanying aphasia. The more severe the impairment, the poorer the prognosis is for recovery.

Characteristics of Severe AOS
  A. Melodic Intonation Therapy- (Sparks and Helm-Estabrooks) . The idea is to have the patient "sing" an utterance being trained, because singing an utterance facilitates production for aphasic patients with an element of verbal apraxia.

 

B. Gestures- introduced into speaking as a form of intersystemic reorganization or deblocking--involves pairing speaking and gesture. The goal is to maintain the verbal response after the gesture has faded.
 

National Institute of Neurological Disorders and Stroke
National Aphasia Association
National Stroke Association
American Academy of Neurology 
Stroke Support Information
Dana Brain Web
 

Bibliography

Brookshire, R. (1992). An introduction to neurogenic communication disorders, 4th edition. St. Louis, MO: Mosby Year Book.

Davis, G. (1993). A survey of adult aphasia and related language disorders 2nd edition. Englewood Cliffs, NJ: Prentice-Hall.

Duffy, J. (1995). Motor speech disorders: Substrates, differential diagnosis, and management. St. Louis, MO: Mosby Year Book.

Haynes, W., Pindzola, R., & Emerick, L. (1992). Diagnosis and evaluation in speech pathology, 4th edition. Englewood Cliffs, NJ: Prentice-Hall.

Love, R., & Webb, W. (1986). Neurology for the speech-language pathologist. Boston, MA: Butterworth Publishers.

Skelly, M. (1979). Amer-Ind gestural code based on universal American Indian hand talk. New York, NY: Elsevier.

White, P. (1997). Pocket reference of diagnosis and management for the speech-language pathologist. Boston, MA: Butterworth-Heinemann.