Aphasia and Apraxia of Speech

Aphasia
• Definition
• Incidence/Prevalence
• Characteristics
• Assessment Measures
• Treatment
• Support
Apraxia
• Definition
• Causes
• Characteristics
• Assessment Measures
• Treatment
• Support

• Aphasia is an acquired neurogenic language
disorder resulting from an injury to the brain, most typically the left hemisphere, that affects all language modalities (ASHA, 2015).
• Stroke is the most common cause of aphasia and apraxia; however, it can also be diagnosed after a lesions or trauma to the brain.

• Approx 35-40% of patients who suffer a stroke are diagnosed with some form of aphasia. (Dickey et al., 2010;
Pedersen, Jorgensen, Raaschou, & Olsen, 1995).
• It is estimated that there are 80,000 new cases of aphasia per year in the United States (National Stroke
Association, 2008).
• The National Institute of Neurological Disorders and
Stroke (NINDS) estimates that approximately 1 million people, or 1 in 250 in the United States today, suffer from aphasia (NINDS, n.d.).

• A language disorder resulting in the difficulty to communicate and understand language.
• The four modalities of language
• Listening comprehension
• Reading comprehension
• Verbal expression
• Writing expression
• Affects on language, not on intellect

• Arcuate fasiculus (language loop)

Wernicke’s
• Decreased auditory comprehension
• Fluent Aphasia
• Most associated with
Apraxia
Broca’s
• Decreased verbal expression
• Non-Fluent Aphasia
– Slow, halting, effortful speech

Wernike – Geshwind Model
(The Brain from Top to Bottom)
• A word is heard
– processed in your auditory cortex
• Wernike’s area (links with a word in your memory)
– word is now associated with a meaning
• A word is read
– processed by your visual cortex
• sent to Wernike’s and again is linked with memory
– word is now associated with a meaning
• A word is read aloud
– originates from the
“dictionary” in Wernike’s
• gets looped to Broca’s area in order to be pronounced
– planning articulators
» motor cortex for speech movement
• A word is spoken
– originates from the
“dictionary” in Wernike’s
• gets looped to Broca’s area in order to be pronounced
– planning articulators
» motor cortex for speech movement

• Listening Comprehension
– Decreased understanding
– Unreliable Y/N
• Writing Expression
– Agraphia: loss in the ability to communicate by writing
• Reading Comprehension
– Alexia: loss in ability to recognize letters, words, etc.
• Verbal Expression
– Word finding: Anomia
– Paraphasias
• perseverative, phonemic, verbal, neologistic etc.

• Screening versus Comprehensive assessment
• Standardized Testing
– BDAE (Boston Diagnostic Aphasia Examination)
– WAB (Western Aphasia Battery
• Non-Standardized Testing
– Observational methods

(ASHA, 2015)

• For information on organizations, research and clinical trials
– St. Luke’s Stroke club
– Academy of Neurologic Communication Science and Disorders
– Aphasia Hope
– National Aphasia Association
– Stroke Association

• Apraxia of speech is a motor disorder that is a result of vascular lesion in the left subcortical region.
• The inability for volitional movement of the speech articulators.
• It is not muscle weakness.

• Disconnect between the words in the brain, and how to form the movements of those speech sounds.
• Limited research on prevalence and incidence.
• Often co-morbidities such as dysarthria
(muscle weakness) or aphasia (language disorder).

• Groping – most often with initiation
• Slowed pace
• Limited or no usable speech
• Difficulty performing “non-speech” tasks upon request
• Awareness and frustration
• Inconsistent errors

• Acquired versus Developmental
• Adult is acquired

• Diagnosed by a speech-language pathologist after informal and formal testing procedures
• Speech sample in conversation
• Oral mechanical examination
• Motor speech evaluation
• Apraxia vs Dysarthria

• Three steps
– Planning
– Sequencing
– Muscle coordination
(slow rate, pacing)
• Gestures
– Guess my communicative intent
• Writing
• Retraining the brain.
Make new connections.
Repetitive practice.
• AAC
– Alphabet boards
– Picture boards

• Melodic Intonation Therapy (MIT)
• PROMPT – involving tactile cues for articulators
• Minimal pairs imitation
• Key word approach
• Phonetic placement
• Practice, practice, practice

• For information on organizations, research and clinical trials
– St. Luke’s Stroke club
– National Institute of Neurological Disorders and
Stroke
– National Institute of Deafness and other
Communication Disorders

• Aphasia and the Brain (2015). Wernike and Broca History. Image retrieved January 11, 2015 from http://aphasia-and-brain.tumblr.com/post/45124007874/wernicke-and-broca-history
• The Brain from Top to Bottom (2015). Broca’s Area, Wernike’s Area, and other Language-Processing
Areas in the Brain. Retrieved January 11, 2015 from http://thebrain.mcgill.ca/flash/d/d_10/d_10_cr/d_10_cr_lan/d_10_cr_lan.html
• National Institute on Deafness and Other Communication Disorders (2015). Apraxia of Speech.
Retrieved January 11, 2015 from http://www.nidcd.nih.gov/health/voice/pages/apraxia.aspx
• National Institute of Neurological Disorders and Stroke (2015). Apraxia Information Page. Retrieved
January 11, 2015 from http://www.ninds.nih.gov/disorders/apraxia/apraxia.htmhttp://
• The Stroke Comeback Center, VA. Williamson, Darlene M.S., CCC-SLP. Adult Acquired Apraxia of
Speech: Principles, Practice and Technology. Retrieved January 11, 2015 from www.ohioslha.org/pdf/Convention/2012%20Handouts/NeuroSC18F.pdf