Apraxia and Articulation Assessment

Study Notes

Apraxia Specific Assessment Procedures

Motor planning capabilities are assessed through imitation and commands in both speech and nonspeech tasks.
DDK (Diadochokinetic) rates and standardized tests are utilized for evaluation.
Signs indicating a specific diagnosis of Apraxia include:
- Variable errors in vowels and diphthongs.
- Presence of nasality and NAE (nasal airflow escape) without CLAP (Consonant-Like Articulation Patterns) is likely indicative of Apraxia of Speech (AOS).
- Issues with prosody noted.
- Increased errors observed in longer utterances, revealing difficulties in speech production.
- Groping behavior is often exhibited.

Articulation vs. Phonological Disorder Differential Diagnosis

When two or more phonemes are represented by the same production (e.g., /t/ for /s/ and /ʃ/), this signals a phonological disorder due to lack of phonemic awareness.
Preservation of phonemic contrast indicates an articulation disorder, where consistent contrasts occur in all word positions (prevocalic, intervocalic, postvocalic).
Peripheral motor-based problems demonstrate generalization of learning deficiencies, suggestive of articulation disorders.
Emerging context sounds show good stimulability in isolated productions, requiring articulation techniques rather than phonological approaches.

Visual Detection

Mirror Test serves for NAE assessment only, not for hypernasality; clouding indicates potential NAE issues.
- Care must be taken with timing to avoid false positives due to normal respiration.
Air Paddle Test, like the mirror test, is only for NAE; intended for voiceless pressure-sensitive consonants but lacks sensitivity.

Tactile Detection

Placing fingers on the nasal area during sound production helps detect vibration, indicating hypernasality, but it is not valid for NAE assessment.

Nasal Cul De Sac Test

Involves producing sounds with and without nose occlusion to compare results and assess for NAE and hypernasality.
For hypernasality, vowels are assessed; no change indicates normal VP (velopharyngeal) movement, while increased nasality with an unoccluded nose suggests hypernasality.
For NAE, the same test assesses pressure-sensitive sounds under analogous conditions.

Listening Tools

Listening tube, stethoscope, or oronasal listener can indicate NAE or hypernasality based on airflow detection.
Use of a straw allows for differentiation: audible airflow suggests NAE, while no airflow indicates hypernasality; it can also assist with lateral lisps.

Speech Production Analysis

Speech Sampling is representative of daily speech use, including stimuli from pictures, word lists, and conversations.
Phoneme assessment includes initial, medial, and final positions to determine the nature of errors (SODA: Substitutions, Omissions, Distortions, Additions).
Information collected includes:
- Phonetic Inventory: All phonemes the patient can accurately produce and in which positions.
- Stimulability: Ability to correctly produce specific sounds when stimulated.
- Nature of errors to guide interventions (articulation vs phonological techniques).
Speech Sample Elicitation can occur through reading, conversational tasks, or delayed imitation.
Percentage of Correct Consonants (PCC) evaluates severity of errors:
- Mild: 85%-100%
- Mild/Moderate: 65%-85%
- Moderate/Severe: 50%-65%

Description

Explore the specific assessment procedures for Apraxia and the differential diagnosis between articulation and phonological disorders. This quiz covers motor planning capabilities, signs of Apraxia of Speech, and key differences between articulation and phonological disorders. Test your knowledge on the steps needed for accurate evaluation.