Motor Speech Disorders and Apraxia of Speech Review

Vocabulary and key concepts covering Apraxia of Speech (AOS), Dysarthria diagnosis, principles of motor learning, neuroplasticity, and specific speech system treatments.

Apraxia of Speech (AOS)

A breakdown in motor planning or motor programming movements of speech, frequently associated with left hemisphere lesions such as a stroke in the MCA.

Non-verbal oral apraxia (NVOA)

The inability to voluntarily perform nonspeech oral movements, such as blowing a kiss or puffing cheeks, despite adequate strength and comprehension.

Limb apraxia

The inability to perform learned purposeful limb movements, like waving goodbye or brushing teeth, despite having adequate strength, sensation, coordination, and comprehension.

Automatic Speech

A context in which AOS speech often improves, contrasting with voluntary speech or novel utterances which typically increase errors.

Spastic Dysarthria

A motor speech disorder characterized by a strained-harsh groaning voice quality, reduced rate, hypernasality, slow AMRs, and imprecise articulation, typically caused by bilateral upper motor neuron impact.

Neuroplasticity: Transference

A principle where plastic change in one set of neural circuits through training can promote concurrent or subsequent plasticity in other training protocols.

Neuroplasticity: Interference

A principle where plasticity in response to one experience can interfere with the acquisition of other behaviors.

Performance (Motor Learning)

A short-term, one-time event during a session that does not always represent long-term adjustments or learning.

Pre-practice

The phase of therapy where the clinician ensures the client understands the task, has clear goals, is motivated, and can explain the target.

Practice Distribution

How a given amount of practice is divided over time, where distributed practice is generally better than massed practice for learning.

Practice Variability

The comparison between practicing one variant of a movement (constant) versus multiple variants (variable), with variable practice being better for generalization.

Practice Schedule

The arrangement of targets, where blocked practice (one phoneme at a time) is better for performance, but random practice (multiple targets) is better for learning.

Error Rates

A session organization factor where an ideal success rate of $60-80\%$ is targeted for tasks.

Attentional Focus

The focus during a task; external goals (reaching an end goal) are generally more accurate for motor learning than internal focus (bodily movements).

Knowledge of Results

A type of feedback condition that is generally superior to knowledge of performance for long-term learning.

Subglottal Pressure

The requirement for 'normal' respiration for speech, providing enough pressure to set the vocal folds in motion and sustain movement through the speech phase.

EMST (Expiratory Muscle Strength Trainer)

A non-speech task/device used to improve respiratory support by having the patient breathe against resistance.

Vocal Efficiency

The ability to produce a strong, clear voice without excessive effort or air loss, assessed via sustained phonation and maximum phonation time.

Vocal Flexibility

The ability to change pitch and loudness as needed for emotional expression and emphasis.

Vocal Stability

The regularity or repetitiveness of sound waves during phonation; a lack of this may manifest as voice tremors or pitch breaks.

Lee Silverman Voice Treatment (LSVT)

An intensive behavioral intervention for Parkinson's Disease focused on five concepts: think loud, high speech effort, intensive treatment, recalibrated loudness, and quantifiable improvements over $4$ sessions for $4$ weeks.

Lombard effect

The phenomenon where speakers naturally increase their vocal intensity when in the presence of background noise.

Hypernasality

A resonance disorder characterized by too much sound energy in the nasal cavity during voiced, oral sounds, often seen in flaccid or spastic dysarthria.

Cul-de-sac resonance

Resonance where sound vibrates in a cavity but is trapped and cannot exit due to an obstruction.

Obligatory errors

Speech errors physically based on structural issues like VPD or dental differences that require physical correction before therapy.

Compensatory errors

Learned speech patterns, such as backed oral productions or nasal fricatives, that require speech therapy rather than just structural correction.

Palatal lift

A prosthetic intervention that raises the soft palate to improve velopharyngeal closure, nasal emission, and intelligibility.

Nasal obturator

A prosthetic device that plugs the nose to improve resonance and speaking effort, though it is not typically a long-term solution.

Naturalness

The degree to which speech sounds normal to a listener and conforms to listener standards regarding stress, intonation, and rhythm.

Strategic Pauses

Intentional pauses placed at syntactic boundaries or meaningful units to improve intelligibility and naturalness.

Rosenbek 8-step continuum

An articulatory-kinematic treatment for AOS that uses integral stimulation and a hierarchy of cueing, starting with choral production and moving to role-playing.

Sound Production Treatment (SPT)

An AOS treatment aimed at improving articulatory accuracy using minimal contrasts, written cues, and phonetic placement cues.

Intersystematic Reorganization

A treatment strategy for AOS that uses intact systems, such as Amerind gestures or singing, to facilitate speech production.

PROMPT

Prompts for Restructuring Oral Muscular Phonetic Targets; a tactile-kinesthetic treatment using hands-on cues to guide speech movement.

Functional Speech Disorders (FSD)

Speech disorders with real symptoms caused by abnormal nervous system function rather than structural damage; symptoms are not intentional.

Malingering

The intentional faking of symptoms, which differs from Functional Speech Disorders where symptoms are involuntary.

PPAOS (Primary Progressive AOS)

A progressive motor speech disorder caused by neurodegenerative disease, characterized by gradual onset, slow speech, and syllable segmentation.

Melodic Intonation Therapy

A rate/rhythm control technique that utilizes melody, rhythm, and hand tapping to improve speech in cases of AOS and nonfluent aphasia.