Apraxia of speech - research and idea's

I've recently had a few patient's with AOS, so decided to update my knowledge using Duffy's text and lay down some ideas based on my observations.

Emotions can help
I have a patient with severe AOS who is better able to communicate when the subject is emotive and they are able to be relaxed. One of my idea's is to chose emotive words/ topics to work on in therapy which are also more meaningful for the client e.g. Home/ discharge, Stroke/ recovery, Family....

The theory: - The Motor speech Programmer's (MSP) left hemisphere functions are strongly linked to the linguistic attributes of speech (phonologic, semantic, syntactic...) and the right hemisphere's MSP functions are more strongly linked to speeches emotional/ affective attributes. Therefore you can get some information from tone of voice etc. and maybe you could use emotional/ affective prompts to support the MSP.

Singing can help
- Clients may be able to sing, count or swear.

I have used singing to allow clients to be stimulable for a sound and then worked on integrating that sound into a word.

Duffy update
Severe Apraxia of speech

• Disturbed planning/ programming of movements for speech (MSP)
• Can occur without impairments on non speech tasks/ without verbal/ reading comprehension impairments (e.g. non-verbal oro motor exam may be normal).
• Often coexists with aphasia and dysarthria.
• Predominantly due to left cerebral hemisphere pathology (especially parietal/ frontal).

Positive indicators for AOS

• Narrative/ conversational speech = most difficult (varying patterns of stress and syllables).
• Difficulties on repetition tasks (challenge speech planning/ programming not word retrieval).
• Sequential Motion Rates (very sensitive to AOS - are the ability to move from one articulatory position to another) e.g. repeat 'catastrophe' 'pataka'

Assessment
Articulation

• Imprecise, distorted substitutions, distorted perseverative substitutions (nanana for banana), distorted anticipatory substitutions e.g. popado for potato, distorted additions.

Rate + prosody 

• SLow rate, variable vowel duration, stress errors on words/ syllables, decreased phonemic accuracy with increased rates.

Fluency

• False starts/ re-starts, effortful groping, sound + syllable repetitions

MSP

• Establishes the plans/ programs for the cognitive (e.g. affect...)/ linguistic (e.g. words) goals of speech.
• Organises motor commands to produce syllables, words and phrases at particular rates/ patterns of stress/ rhythm.
• Linguistic input to the MSP = from the Left Hemisphere's perisylvian area (temporoparietal cortex, post. frontal lobe, insula, basal ganglia and thalamus)
• Selects, sequences, activates and controls pre-programmed movement sequences.

AOS and other apraxia's

• AOS can co-occur with limb apraxia (deficits with purposeful limb movements).
• This can impact on communicative gesture use/ AAC accessibility.