Apraxia of Speech Features and Diagnosis

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Questions and Answers

What does the assessment of diadochokinesis primarily measure?

Overall speech intelligibility

Ability to make antagonistic movements in quick succession (correct)

Self-rating of speech effort

Ability to articulate words clearly

Between Alternating Motion Rates (AMRs) and Sequential Motion Rates (SMRs), which is expected to perform worse in individuals with apraxia of speech (AOS)?

Both AMRs and SMRs perform equally

SMRs due to increased motor planning required (correct)

AMRs because they are simpler tasks

SMRs as they are less familiar

What is an example of an automatic speech task?

Counting from 1 to 10 (correct)

Repeating a multisyllabic word

Reading a passage aloud

Describing a picture

Which type of errors are assessed in transcription during speech analysis?

Distortions and substitutions Signup and view all the answers

How does the rate of speech help in assessing AOS?

Increased errors may appear at faster rates Signup and view all the answers

What is typically required in self-assessments of speech by clients?

Visual supports to aid comprehension Signup and view all the answers

Which of the following speech tasks generally requires more motor planning?

Days of the week backwards Signup and view all the answers

Which aspect is NOT typically evaluated in overall speech intelligibility assessments?

Response time during tasks Signup and view all the answers

What is a core speech symptom used for diagnosing Apraxia of Speech (AOS)?

Sound distortions Signup and view all the answers

What are 'extended intersegment durations' defined as?

Lengthened pauses between sounds and words Signup and view all the answers

What type of error is most common in Apraxia of Speech?

Distorted substitutions Signup and view all the answers

Which symptom indicates prosodic deficits in individuals with AOS?

Restricted pitch alteration Signup and view all the answers

What is the term for the phenomenon when individuals insert an 'intrusive schwa' between segments?

Syllabification Signup and view all the answers

What does 'extended segment durations' refer to?

Lengthened production of consonants and vowels Signup and view all the answers

Which of the following may be an additional feature seen in AOS but not used for diagnosis?

Intonation restrictions Signup and view all the answers

Which symptom can make speech sound unnatural in individuals with AOS?

Monotonous sound Signup and view all the answers

What is the likelihood of individuals with AOS producing equal lexical stress in multisyllabic words?

High likelihood Signup and view all the answers

What commonly occurs in speech patterns of those with AOS?

Slowed rate of speech Signup and view all the answers

What is a primary consideration when assessing written language ability in the context of AOS?

Can the person understand written words? Signup and view all the answers

How is severity of AOS typically rated?

Subjectively by clinicians based on judgement of speech Signup and view all the answers

What does the Apraxia Battery for Adults (ABA) include?

A range of tasks to elicit speech features characteristic of AOS Signup and view all the answers

What is the purpose of the Apraxia of Speech Rating Scale (ASRS)?

To describe and quantify characteristics indicative of AOS Signup and view all the answers

What does the ASRS rating scale consist of?

A 5-point scale describing presence or absence of speech characteristics Signup and view all the answers

Which of the following factors is NOT considered when rating the severity of AOS?

Physical fitness level of the individual Signup and view all the answers

What are the characteristics evaluated by the ASRS categorized into?

Present or absent characteristics of AOS Signup and view all the answers

What has limited the usefulness of the Apraxia Battery for Adults (ABA) for diagnosing AOS?

Outdated diagnostic criteria Signup and view all the answers

What is apraxia of speech primarily characterized by?

Difficulty with motor planning and programming for speech Signup and view all the answers

Which hemisphere of the brain is typically associated with lesions resulting in apraxia of speech?

Left hemisphere Signup and view all the answers

What co-occurring condition is most often found with apraxia of speech?

Aphasia Signup and view all the answers

What is the best practice for assessing apraxia of speech?

Perceptual identification of a cluster of features Signup and view all the answers

What type of movement is affected by apraxia of speech?

Volitional movements for speech Signup and view all the answers

How does apraxia of speech generally manifest in its severity?

A range from inability to speak to mildly imprecise speech Signup and view all the answers

What is one of the psychosocial impacts of disordered speech due to apraxia?

Difficulties in communication with others Signup and view all the answers

Which of the following options is least likely to be a focus during assessment of apraxia of speech?

Patient's musical ability Signup and view all the answers

What role do error signals play in motor learning?

They modify ongoing movement. Signup and view all the answers

Which of the following is not considered a discriminatory feature of AOS?

Increased phonetic accuracy Signup and view all the answers

How do individuals with AOS usually perceive their speech errors?

They often underestimate their errors. Signup and view all the answers

What effect does word length have on speech errors in individuals with AOS?

Errors increase with longer words. Signup and view all the answers

Which feature is often seen in AOS but not unique to it, making it unreliable for diagnosis?

Groping Signup and view all the answers

What is suggested regarding the relationship between error awareness and speech fluency in treatment for AOS?

Increased self-correction can hinder fluency. Signup and view all the answers

How did historical views on error variability in AOS differ from current understanding?

Errors were thought highly variable. Signup and view all the answers

Why is 'effort' in speech difficult to define in individuals with AOS?

It is subjective and varies by individual. Signup and view all the answers

What does emerging research indicate about multisyllabic words for individuals with AOS?

They are more challenging due to motor planning demands. Signup and view all the answers

What is one primary goal of assessing AOS?

To enhance therapy planning. Signup and view all the answers

How might an individual's ability to self-correct affect their speech?

It can lead to decreased fluency. Signup and view all the answers

What characterizes 'islands of error-free speech' in AOS?

Periods where speech is fluent despite other issues. Signup and view all the answers

What is a key characteristic of articulatory groping in AOS?

Visible attempts to pronounce accurately. Signup and view all the answers

What does increasing error variability imply about AOS diagnosis over time?

It suggests changing criteria for diagnosis. Signup and view all the answers

Study Notes

Apraxia of Speech (AOS) Definition & Features

AOS is a neurogenic speech disorder that affects the motor planning and programming of movements for speech.
AOS can range in severity from inability to speak to mildly imprecise or unnatural sounding speech.
AOS can occur in both children and adults.
Although AOS is less common than Aphasia, AOS is often seen alongside Aphasia. AOS is also sometimes seen alongside dysarthria.

AOS Diagnosis

Diagnosis of AOS is based on a "perceptually derived cluster of behaviors" (McNeil et al., 2017, p. 201).
The "kernel features" of AOS are sound distortions, extended segment and intersegment durations, and prosodic deficits.
Sound distortions: These may be substitutions, distortions or distorted substitutions.
Extended segment durations: These are lengthened productions of consonants and vowels which creates a slower perception of speech.
Extended intersegment durations: These are lengthened pauses between sounds and words causing speech to appear segmented.
Prosodic deficits: Individuals with AOS may have restricted alterations in pitch, intonation and loudness making their speech appear monotonous. They are also likely to show equal lexical stress.

Non-Discriminatory Features

These features are often seen in AOS but are not considered "kernel" features.
These features include: groping, effortful speech, difficulty initiating speech, awareness of errors, self-correction, variability of errors, increasing errors with word length, automatic speech is better than propositional speech, and islands of error-free speech.
These features are not unique to AOS and therefore not reliable for diagnosis of AOS on its own.

Assessment Principles

The goal of assessment should be to obtain information that will help you plan a therapy approach (Ballard et al., 2002).
Assessment should include diadochokinesis, perceptual speech tasks, and observation for patterns of errors.

Diadochokinesis Assessment

This is an assessment of the ability to make antagonistic movements in quick succession.
There are two common diadochokinesis tasks
- Alternating Motion Rates (AMRs): /ppppp//ttttt//kkkkk/
- Sequential Motion Rates (SMRs): /ptk/ptk/ptk/ptk/
These tasks assess the accuracy of articulation, speed and sequencing.
SMRs will typically be worse than AMRs in AOS because they require increased motor planning.

Perceptual Speech Tasks

Perceptual speech tasks include automatic speech tasks (e.g. counting 1-10, days of the week), repetition and imitation of various words and sentences as well as narrative or discourse samples.
These tasks should be elicited with multiple repetitions to assess variability.
Observe the client’s performance on automatic versus volitional tasks.
Observe the client’s performance on repetition, propositional speech, and reading.
Observe the client’s performance with a faster rate of speech, as errors may appear with increased rate.

Additional Assessments

Assess overall speech intelligibility.
Ask the client to provide a self-rating of their speech or of the effort required to speak.
Conduct expressive and receptive language assessments to determine if aphasia is present.
Conduct cognitive assessments and written language assessment.

Severity Assessment

There is no standard method of assessing severity of AOS.
Severity is typically rated subjectively by clinicians, based on judgement of speech quality.
When rating severity, consider factors like intelligibility scores, frequency of errors in speech, percentage of sounds produced correctly, and subjective degree of effort of speaking.

Apraxia of Speech Rating Scale (ASRS)

The ASRS is a recently published tool that is designed for description and quantification of characteristics indicative of AOS.
It is a 5-point scale which describes presence or absence of particular speech characteristics, and their severity.
The ASRS is divided into 16 items based on:
- Discriminative of AOS
- Apparent in AOS but also found in Aphasia
- Apparent in AOS but also found in Dysarthria
- Apparent in AOS but also found in both Aphasia and Dysarthria

Formal assessments

The Apraxia Battery for Adults (ABA) is a widely used assessment used for AOS; however, it is based on diagnostic criteria that have been updated since the tool’s creation.
ABA contains many useful tasks and stimuli for assessment.

AOS Recap

Acquired neurogenic disorder of motor planning and programming of volitional movements for speech.
Ranges in severity from inability to speak to mildly imprecise or unnatural sounding speech.
Results from a variety of usually left hemisphere lesions.
Frequently co-occurs with aphasia and less frequently with dysarthria.
There are several standardized and non-standardized assessment options available to diagnose AOS.
Assessment should consider performance on a battery of speech tasks, as well as examining the functional and psychosocial impact of disordered speech.

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Description

Explore the characteristics and diagnostic criteria of Apraxia of Speech (AOS), a neurogenic speech disorder affecting motor planning for speech. Understand the core features associated with AOS and its relation to other speech disorders like Aphasia and Dysarthria. This quiz will help reinforce your knowledge of AOS in different age groups.