This thesis provides new insights about how the brain controls skilled movements, through the study of limb apraxia in two major neurological disorders: Stroke and Corticobasal Syndrome (CBS). Limb apraxia is a cognitive-motor deficit characterized by impairment in the performance of skilled movement. The Conceptual-Production systems model, used as framework in this thesis, proposes that skilled movement is under the control of three systems: a sensory/perceptual system, a conceptual system and a production system. Deficits in any of these systems produce limb apraxia, and depending on which system is affected, a distinct pattern of apraxia emerges. This information processing approach was used to evaluate performance levels, study brain asymmetries and discern patterns of deficits in each population. In addition, longitudinal assessments in sample subsets revealed patterns of recovery after stroke and of progression in CBS. The first study examined acute-subacute and chronic stroke patients with left (LHD) and right hemisphere damage (RHD) for their ability to pantomime and imitate transitive and intransitive gestures. The results indicated that LHD and acute-subacute were more severely impaired. Concurrent deficits in pantomime and imitation were most common, especially after LHD. Since acute-subacute patients were more severely impaired, in the absence of any therapies, it is likely that some degree of recovery occurs over time. The second study study examined longitudinal recovery in a series of transitive gestures tasks among stroke patients and indicated that patients significantly recovered in all tasks, except in Action Identification, a conceptual apraxia task which probes knowledge of actions. Finally, two comparative studies were conducted in CBS, a neurodegenerative disorder in which apraxia is common, making this one of the first studies that evaluated patient performance on a complete limb apraxia battery. The first study found that patients were often impaired on all gesture production tasks, while conceptual knowledge of gestures and tools was usually preserved. A case series constituted the second study, which documented the progression of apraxia in CBS demonstrating that, while deficits in gesture production usually are present at first examination, deficits in conceptual knowledge are infrequent and in many cases do not develop at all. Study limitations were discussed and it was suggested that future research should expand on our findings for recovery in stroke and progression in CBS.

Apraxia of speech (AOS) is a neurogenic speech disorder that is characterised by deficits in the articulatory and prosodic domains of speech production. A range of physiologic assessment techniques have been employed in an attempt to elucidate the physiological underpinnings of articulatory and prosodic defects in AOS. However, despite the advancement of electromagnetic articulography (EMA), a technique that facilitates safe, non-invasive assessment of intra-oral structures, little research has investigated lingual kinematics during speech production in participants with AOS. Tongue-to-palate contact patterns, on the contrary, have been investigated in AOS. However, most of this research relied upon descriptive analysis, rather than instrumental techniques including electropalatography (EPG). Therefore, the present thesis aimed to utilise EMA and EPG to provide a comprehensive assessment of lingual movement and tongue-to-palate contact patterns during word-initial consonant singletons and consonant clusters, during mono- and multisyllabic words, in AOS. The strength of coupling between the tongue and jaw and tongue-tip and tongue-back was also examined, as was consonant cluster coarticulation. Five participants (three females and two males) with AOS and a concomitant non-fluent aphasia participated in the project. The mean age of the group at the time of the EMA assessment was 53.6 years (SD = 12.60; range 35 - 67 years). At the time of initial assessment, all participants were a minimum of 12 months post onset of stroke (M = 1.67 years; SD = 0.72). Perceptual analysis indicated that each of the five participants with AOS presented with the following mandatory characteristics: sound distortions, sound prolongations, syllabic speech output, and dysprosody. A control group of 12 neurologically unimpaired participants (8 male, 4 female; M = 52.08 years; SD = 12.52; age range = 29 - 70 years) also participated in the study. The apraxic speakers’ tongue-tip and tongue-back movements were initially profiled during monosyllabic word production using EMA. Movement duration, distance, maximum velocity, maximum acceleration and deceleration, and velocity profile index values were recorded during word-initial consonant singletons (i.e., /t, s, l, k/) and consonant clusters (i.e., /kl, sk/). Results indicated that the participants with AOS evidenced significantly prolonged movement durations and, in some instances, significantly greater articulatory distances, relative to the control group. All measures pertaining to speed appeared to be relatively unimpaired. Phonetic complexity had a variable impact on the articulation of word-initial consonants. The results were able to account for the overall slow rate of speech exhibited by the participants with AOS. In a subsequent study, EMA was employed to investigate the impact of increasing word length on lingual kinematics for five participants with AOS. Target consonant singletons and consonant clusters were embedded in the word-initial position of one, two, and three syllable words (e.g., tar, target, targeting). Movement duration appeared to be most sensitive to the effect of word length during consonant singleton production. However, word length effects were absent during consonant cluster production. The data were discussed in the context of motor theories of speech production. The final EMA investigation examined the strength of coupling between the tongue and jaw and tongue-tip and tongue-back during /ta, sa, la, ka/ syllable repetitions, in a group of five participants with AOS. In comparison to the control group, four participants with AOS exhibited significantly stronger articulatory coupling for alveolar and/or velar targets, indicative of decreased functional movement independence. The reduction in functional movement independence was thought to reflect an attempt to simplify articulatory control, or alternatively, a decrease in the ability to differentially control distinct articulatory regions. To complement the EMA data, EPG was employed to investigate the spatial characteristics of linguopalatal contact during word-initial consonant singletons (i.e., /t, s, l, k/) and consonant clusters (i.e., /kl, sk/) in three participants with AOS. Through the use of quantitative and qualitative analysis techniques, misdirected articulatory gestures (e.g., double articulation patterns), distorted linguopalatal contact patterns (alveolar fricatives), lingual overshoot, and for one participant, significantly greater spatial variability were identified in the linguopalatal contact data. Pattern of closure appeared to be relatively unimpaired during alveolar plosive and approximant productions, and lingual undershoot and true omission errors were absent. The results were discussed in relation to their impact on phonetic distortion. A subsequent EPG study examined the temporal and spatial aspects of consonant cluster coarticulation in three participants with AOS. Target stimuli included ‘scar’ and ‘class’. In contrast to what was expected, each of the participants with AOS appeared able to coproduce elements within a consonant cluster. Appropriately, pattern of linguopalatal contact did not appear to be influenced by coproduction. Amount of linguopalatal contact did differ significantly on occasion. Coarticulatory effects were appropriately absent for each of the participants with AOS during alveolar fricative production in ‘scar’; however, the control group and each of the apraxic speakers exhibited place of articulation assimilation during velar stop production. The control group and two participants with AOS produced discrete velar and alveolar articulations during ‘class’; one participant with AOS evidenced coarticulatory effects during the /kl/ cluster. The research findings indicated that consonant cluster coarticulation was generally maintained in word-onset position, and it was postulated that future research should endeavour to investigate consonant cluster coarticulation in consonant sequences that span a syllable boundary. The EMA and EPG research findings presented in this thesis inform about the underlying physiological nature of articulatory disturbances in AOS. These findings will be discussed in the context of contemporary theories of speech motor control.

Children with childhood apraxia of speech (CAS) are likely to experience severe and persistent spoken and written language disorder. There is a scarcity of intervention research, however, investigating techniques to improve the speech and literacy outcomes of this population. The series of 5 experiments reported in this thesis investigated phonological awareness and early reading development in children with CAS and trialled a new intervention designed to advance the spoken and written language development of those affected. In the first experiment (presented in Chapter 2), a comparison of 12 children with CAS, 12 children with inconsistent speech disorder (ISD), and 12 children with typical speech-language development (TD) revealed that children with CAS may be particularly susceptible to phonological awareness and reading deficits. There was no difference in the articulatory consistency and speech severity of the CAS and ISD groups, and no difference in the receptive vocabulary of the CAS, ISD, and TD groups. The children with CAS exhibited poorer phonological awareness scores than the comparison groups and had a greater percentage of participants performing below the expected range for their age on letter knowledge, real word decoding, and phonological awareness normative measures. The children with CAS and ISD performed inferiorly than the children with TD on a receptive phonological representation task. The results showed that the children with CAS had a representational component to their disorder that needed to be addressed in intervention. In the second experiment (presented in Chapter 3), a follow-up pilot study was conducted to examine the long-term effects of a previously conducted intensive integrated phonological awareness programme (7 hours of intervention over 3 weeks) on 2 children with CAS. The children aged 7;3 and 8;3 at follow-up assessment had previously responded positively to the intervention. Results showed that the children were able to maintain their high accuracy in targeted speech repeated measures over the follow-up period. One child was also able to maintain her high accuracy in phonological awareness repeated measures. The children performed superiorly on a standardised phonological awareness measure at follow-up than at pre-intervention. Non-word reading ability showed a sharp increase during the intervention period, while minimal gains were made in this measure over the follow-up period. The findings suggested that an integrated intervention was a potential therapeutic approach for children with CAS. In the third experiment (presented in Chapter 4), the effectiveness of an integrated phonological awareness programme was evaluated for the 12 children (identified in the first experiment) aged 4 to 7 years with CAS. A controlled multiple single-subject design with repeated measures was employed to analyse change in trained and untrained speech and phoneme segmentation targets. A comparative group design was used to evaluate the phonological awareness, reading, and spelling development of the children with CAS compared to their peers with TD over the intervention. The children participated in two 6- week intervention blocks (2-sessions per week) separated by a 6-week withdrawal block. Seven children with CAS made significant gains in their production of trained and untrained speech words with 7 of these children demonstrating transfer of skills to connected speech for at least one target. Ten children showed significant gains in phoneme awareness, and 8 of these children demonstrated transfer of skills to novel phoneme awareness tasks. As a group, the children with CAS demonstrated accelerated development over the intervention period in letter knowledge, phonological awareness, word decoding, and spelling ability compared to their peers with typical development. In the fourth experiment (presented in Chapter 5), the speech, phonological awareness, reading, and spelling skills of children with CAS and TD were re-evaluated 6- months following completion of the intervention programme. A measure of reading accuracy and reading comprehension in a text reading task was administered to the children with CAS. There was no difference in the performance of the children with CAS in post-intervention and follow-up assessments. The children with CAS and children with TD presented with similar relative change in phonological awareness, reading, and decoding measures over the follow-up period. The connected reading performance of children with CAS mirrored their phonological awareness and decoding skills. The findings demonstrated that children with CAS were able to maintain gains achieved during the intervention but may need further support to promote sustained development in written language. In the fifth experiment (presented in Chapter 6), the long-term effects of the integrated phonological awareness programme for identical twin boys who participated in the research intervention at pre-school were examined. The study examined Theo and Jamie's spoken language, phonological awareness, reading, and spelling development during their first year of schooling. The results pointed to the benefit of providing phonological awareness within a preventative framework for children with CAS. Theo and Jamie experienced continued growth in speech and phonological awareness skills. They exhibited age-appropriate reading and spelling development during their first year of formal literacy instruction. It was concluded from this series of experiments that children with CAS are particularly vulnerable to phonological awareness and early reading difficulty, and that an integrated phonological awareness intervention is an effective means of developing speech, phonological awareness, reading, and spelling skills in most children with CAS. The intervention appears to target processes underlying spoken and written language development in this population. The results are discussed within a phonological representation deficit hypothesis of CAS and clinical implications of the findings are highlighted.

Thesis (M.S.)--Eastern Illinois University, 2010. / Includes bibliographical references (leaves 57-62).

Made available in DSpace on 2015-07-22T20:49:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-12-31 / Objetivo: Verificar a inter-relação entre a memória operacional e a apraxia verbal e explorar quais os componentes desta memória estariam envolvidos na programação motora da fala. Métodos: Foram avaliados 22 sujeitos apráxicos e 22 controles. Foram aplicados um teste de compreensão e um protocolo para avaliar e classificar o grau da apraxia de fala. Para investigar a memória operacional dos indivíduos, foram aplicados o teste de span de dígitos na ordem direta e inversa, um teste de repetição de palavras curtas e longas, sendo que ambos investigam o funcionamento da alça fonoarticulatória e o Rey Auditory Verbal Learning Test, que investiga, além da alça fonoarticulatória, o buffer episódico. Resultados: Através da análise estatística realizada, algumas diferenças significantes foram encontradas. O desempenho dos apráxicos nos testes de memória, tanto no span de dígitos direto e inverso, quanto na repetição de palavras curtas e longas e no Rey Auditory Verbal Learning Test foi estatisticamente significante mais baixo que o desempenho dos controles. Também foi evidenciado que a performance entre os apráxicos em todos os testes de memória foi semelhante, independentemente do grau da apraxia. Conclusão: A partir dos resultados citados anteriormente, o estudo concluiu que os indivíduos com apraxia de fala apresentam um déficit na memória operacional e que este déficit está mais relacionado ao processo articulatório da alça fonoarticulatória. Além deste achado, pôde-se observar que o grau de comprometimento do déficit de memória operacional apresentado pelos apráxicos é independente do grau de apraxia de fala destes indivíduos. / To verify the interference of working memory in the apraxia of speech and explore which components of this memory would be involved in the motor planning of speech. Methods: There were assessed 22 apraxic subjects and 22 control subjects. There were administered a comprehension test and a protocol used to assess and classify the degree of apraxia of speech. To investigate working memory in the subjects, digit span forward and backward test, and a short-lenght and long-lenght word repetition test, both able to assess the phonoarticulatory loop, and the Rey Auditory Verbal Learning Test, which investigates both the phonoarticulatory loop and the episodic buffer, were administered. Results: The statistical analysis of the study showed some significant differences. The apraxic subjects performances in the memory tests, in the forward and backward digit span test, as well as in the short-lenght and long-length word repetition test, and in the Rey Auditory Verbal Learning Test was statistically significantly lower than the performance of the control group. It was also emphasized that the performance among the apraxic subjects in all of the memory tests was similar, independently on the degree of the apraxia. Conclusion: From the results mentioned earlier, the study concluded that subjects with apraxia of speech present a working memory deficit and that this deficit is more related to the articulatory process of the phonoarticulatory loop. Furthermore, a degree of compromise in the working memory deficit shown by the apraxic subjects is independent from the degree of apraxia of speech in these individuals. / TEDE / BV UNIFESP: Teses e dissertações

FAS is a speech disorder characterized by changes to the normal speech patterns of the native language. This speech impairment is usually due to stroke or brain injury. Segmental, suprasegmental and prosodic features are altered. FAS speakers’ speech is perceived as foreign rather than disordered. It may be because the speech remains highly accurate and the impairments are generally within the permissible boundaries of the phonological and phonetic variants of the language. In terms of perceptual impression, FAS patients’ speech is placed between speakers with a really foreign accent and the native speaker. Some researchers propose that the impression of foreignness in FAS speakers’ accent may be caused by the listeners misinterpretation of speech markers. Lesions leading to FAS are still not completely understood; some hypothesize that the lesion is small or even down to the size of a single gyrus. New evidence suggests that FAS may be a disorder of the articulate velocity and position maps. The syndrome can be life changing to those affected. Patients report that they are no longer able to recognize themselves speaking a new accent. A whole new persona is born when the accent emerges. This paper presents a review of the syndrome’s features, including its neuropsychological/neuroanatomic aspects, its relationship with AoS and dysarthria, and the syndrome’s psychological implications.

Background: Diagnostic accuracy and reliability of acquired apraxia of speech (AOS) in the presence of co-occurring aphasia and/or dysarthria is crucial for appropriate treatment selection and clinical decision making. However, overlapping symptomology and lack of operationalization of AOS assessment methods have contributed to inadequate interrater reliability of perceptual measures differentially diagnostic of AOS. Purpose: This study investigated factors influencing the operationalization of AOS assessment methods, primarily interrater reliability of perceptual characteristics of differentially diagnostic (i.e., phonetic and prosodic errors) measures in order to inform assessment methods in AOS with concomitant aphasia. In addition, several other factors influencing the operationalization of AOS assessment methods were explored including: the utility of a pre-existing stimulus readily available in a standardized aphasia assessment (WAB-R), interrater reliability of non-discriminatory characteristics of AOS (i.e., auditory groping and false starts), the influence of alternating motion rates (AMRs) and sequential motion rates (SMRs) on a diagnosis of AOS, and the influence of the WAB-R subtests on error production by diagnostic group. Methods: Forty participants presenting with varying aphasia subtypes and severities and potential motor speech impairment were included. Speech production errors were analyzed by four raters using narrow transcription methods in response to the WAB-R spoken language subtest stimuli (Naming, Repetition, and Spontaneous Speech subtests) of the WAB-R. Interrater reliability of perceptual measurement of both differentially diagnostic and non-discriminatory features of AOS when using consistent stimuli (WAB-R), measures (Apraxia of Speech Rating Scale) and trained raters using narrow transcription methods were examined. In addition, percentage agreement of AOS diagnoses with and without the inclusion of AMRs/SMRs, as well as the influence of WAB-R subtest on error production across groups with AOS with concomitant aphasia and those with aphasia only were also examined. Results: Both differentially diagnostic as well as non-discriminatory speech characteristics were shown to demonstrate adequate interrater reliability across a variety of aphasia subtypes and severities of both AOS and aphasia. Adequate agreement between a diagnosis of AOS with and without the inclusion of AMRs/SMRs was reported as well as a lack of significant differences of phonetic and prosodic error production between subtests. Conclusion: The current work provides preliminary evidence of adequate interrater reliability of perceptual features of AOS using consistent stimuli (WAB-R), measures (Apraxia of Speech Rating Scale), and trained raters using narrow transcription. Findings from this work also support the inclusion of the AMRs/SMRs in AOS assessment and highlight the importance of their role when assessing individuals with borderline/mild motor speech impairments. These preliminary results support the consistency and operationalization of assessment methods through the investigation of reliability of perceptual measurements of differentially diagnostic characteristics of AOS in the presence of aphasia.

PURPOSE: The purpose of this qualitative descriptive study was to explore the experiences of emerging adults with idiopathic CAS, as they reflected on their transitions through childhood, adolescence, and young adulthood. SPECIFIC AIMS: Describe the experiences of emerging adults with idiopathic CAS as they reflect on developmental stages of childhood, adolescence, and young adulthood, including the situational experiences of transition occurring between elementary, middle, high school, and post-secondary education, training, or work. Identify strategies and the effectiveness of the strategies utilized by emerging adults with idiopathic CAS to manage experiences during different developmental stages and situational experiences of transition occurring between elementary, middle, high school, and post-secondary education, training, or work. FRAMEWORK: Meleis’ Transitions Theory. DESIGN: A qualitative descriptive design with purposive sampling was used. Data was analyzed using thematic analysis. RESULTS: Findings support the use of Transitions Theory. Three major themes were identified: The Child’s Environment, Implications of CAS, and Strategies. The school environment contributed to many implications for children. Older children were able to develop strategies to overcome challenges. In the school setting, children did not access nurses for concerns related to their CAS. CONCLUSIONS: CAS creates many challenges for children. Emerging adults with CAS report that environments in which people are knowledgeable, patient, understanding, accepting, and supportive help them express themselves freely despite their speech impairment. The nurse’s role in supporting children with CAS during grade school is untapped as they were largely invisible to the children as a potential resource for anything other than an injury or illness. To better facilitate supportive environments in which children with CAS can flourish, nursing assessment and interventions are needed.

No description available.

Focus has turned from emphasis on phonetic sound errors to phonologic rule systems in the study of articulation disorders. The current theory proposes that the phonological disorders which children experience are controlled by higher levels in the brain than those that control the motor functioning of the brain. The purpose of the present study was to compare the use of phonological processes by a group of school-age children with moderate to severe multiple articulation disorders (MAD) with developmental apraxia of speech (DAS) to the phonological processes used by those without developmental apraxia of speech. For the purposes of this study, those without DAS were classified as functional articulation disorder (FAD).