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University of New South Wales *
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485
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Communications
Date
Nov 24, 2024
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docx
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6
Uploaded by ChancellorElectron10813
Differential Diagnosis: Apraxia of Speech (AOS)
Apraxia of Speech (AOS) is a motor speech disorder characterized by difficulty with the planning and
programming of speech movements. In the case of Mr T, the following information supports a
potential diagnosis of AOS:
1. Nature and Level of Breakdown:
Mr T exhibits effortful speech and production errors, indicating difficulty in planning and executing
the precise movements required for speech production. He reported that his thoughts were clear
and he was able to form sentences in his mind, suggesting that the breakdown is in the motor
planning and programming stage rather than in language comprehension or formulation.
2. Spared and Impaired Sensorimotor Speech Processes:
a. Spared:
- Resonance: Mr T's resonance was unremarkable, suggesting that the velopharyngeal function is
intact.
- Single-word comprehension and object knowledge: Mr T demonstrated no difficulties in these
areas, indicating that his language comprehension and semantic memory are functioning well.
b. Impaired:
- Speech affected by the number of syllables: Mr T struggles with multisyllabic words, indicating
difficulty in sequencing the necessary motor movements for longer words.
- Inconsistent speech: Mr T's speech is slow, unintelligible at times, and dysrhythmic. This
inconsistency in speech production is a characteristic feature of AOS.
- Oral diadochokinetic (DDK) movements: Mr T's DDK movements were found to be mild but slow
and dysrhythmic, further supporting the presence of AOS.
In summary, Mr T's symptoms are consistent with a diagnosis of Apraxia of Speech (AOS), a motor
speech disorder characterized by difficulties in motor planning and programming of speech
movements. The nature of the breakdown suggests impairments in the sensorimotor speech
processes involved in speech production, specifically in the planning and execution of precise
movements for speech.
References:
- Duffy, J. (2013). Motor Speech Disorders: Substrates, Differential Diagnosis, and Management.
Elsevier Health Sciences.
- American Speech-Language-Hearing Association (ASHA). (n.d.). Apraxia of Speech (Adult). Retrieved
from
https://www.asha.org/practice-portal/clinical-topics/acquired-apraxia-of-speech/#collapse_6
Assessment (453 words)
In order to effectively manage the client, Mr T, who is suspected to have apraxia of speech, it is
important to gather additional information through various assessments. These assessments will
help determine the underlying cause of Mr T's speech difficulties and inform the treatment plan.
1. Detailed Case History:
A detailed case history will provide important information about Mr T's background, medical history,
current symptoms, and impact on daily activities. It will help identify any potential contributing
factors such as previous strokes, head injuries, or other neurological conditions that may be relevant
to the speech disorder.
2. Oral Peripheral Examination (OPE):
An OPE will assess the range of movement and strength of the articulators involved in speech
production. By examining the lips, tongue, jaw, and velopharyngeal function, the clinician can
determine if there is any inconsistency in the range of movement, which is characteristic of apraxia
of speech. In the case of apraxia of speech, the OPE findings will be within normal limits, indicating
that the speech difficulties are not due to muscle weakness or paralysis.
3. Speech Tasks:
Speech tasks such as conversation, describing the cookie theft picture, or reading a passage (e.g.,
Grandfather's Passage) can provide valuable information about Mr T's speech production abilities.
These tasks allow the clinician to observe the consistency and accuracy of speech production, as well
as the presence of errors or distortions. In the case of apraxia of speech, speech will be characterized
by inconsistent errors, difficulty with longer and multisyllabic words, and impaired prosody.
Dysarthria, on the other hand, typically shows consistent errors and may present with weakness or
slurred speech.
4. Apraxia Battery for Adults - 2nd Edition (ABA-2):
The ABA-2 is a standardized assessment specifically designed to assess apraxia of speech in adults. It
includes various tasks that measure different aspects of apraxia, such as sound sequencing, sound
errors, and prosody. By administering this assessment, the clinician can determine the severity and
characteristics of Mr T's apraxia of speech and establish a baseline for treatment planning.
5. Apraxia Speech Rating Scale (ASRS):
The ASRS is a clinical tool that allows the clinician to rate the severity of apraxia of speech based on
various speech characteristics. It includes scoring for articulatory agility, prosody, phonatory control,
and overall speech intelligibility. The ASRS provides a quantitative measure of apraxia of speech
severity, which can be useful for tracking progress and evaluating the effectiveness of treatment
interventions over time.
Interpreting the results of these assessments will help differentiate apraxia of speech from other
motor speech disorders, such as dysarthria. In the case of apraxia of speech, the OPE will show
normal oral peripheral functioning and the speech tasks will reveal inconsistencies, errors in
movement sequencing, and impaired prosody. The ABA-2 and ASRS will provide objective measures
of the severity and characteristics of Mr T's apraxia of speech, guiding the development of an
individualized treatment plan.
By gathering this additional assessment information, the speech pathologist can make a more
accurate diagnosis of apraxia of speech and tailor an appropriate treatment plan to address Mr T's
specific speech difficulties. Treatment strategies for apraxia of speech typically focus on improving
the coordination and sequencing of speech movements through tasks such as repetitive practice,
phonetic placement cues, and rate control techniques. Direct behavioral approaches, such as
Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT), can also be used to facilitate
accurate speech production. The overall goal of treatment is to improve Mr T's speech intelligibility
and functional communication abilities, ultimately enhancing his quality of life and participation in
activities.
https://www.asha.org/practice-portal/clinical-topics/acquired-apraxia-
of-speech/#collapse_6
ICF framework
Based on the information provided, Mr T may experience activity and participation challenges
following discharge home. These challenges may include difficulties in his work, social interactions,
and leisure activities.
In terms of work, Mr T was previously employed as a human resources manager for a start-up tech
company. With his current speech difficulties, he may find it challenging to communicate effectively
with colleagues, clients, and employees. This could impede his ability to fulfill his job responsibilities,
such as conducting meetings, giving presentations, and providing instructions. Additionally, his slow
and unintelligible speech may result in misunderstandings and frustration for both himself and his
coworkers. Therefore, intervention priorities may include strategies to improve Mr T's speech clarity
and intelligibility in professional settings, as well as developing compensatory strategies to aid in
communication, such as the use of written communication or assistive technology.
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In terms of social interactions, Mr T's difficulties with speech production and comprehension may
impact his ability to engage in conversations with friends and family. His slow and effortful speech, as
well as the difficulty in getting started in conversations, may lead to social isolation and frustration.
Additionally, his partner, Mr J, may struggle to understand him during conversations, which can strain
their relationship and lead to feelings of frustration and helplessness. Therefore , intervention
priorities may include strategies to improve Mr T's communication in social settings, such as speech
therapy techniques to improve speech fluency and intelligibility. It may also be beneficial to provide
Mr J with education and support on how to best communicate with Mr T and understand his needs.
In terms of leisure activities, Mr T enjoys playing hockey and spending time with friends. His speech
difficulties may impact his ability to participate fully in these activities. For example, he may have
difficulty communicating with teammates and coordinating game strategies, or he may struggle to
engage in conversations and socialize with friends during social outings. Intervention priorities may
include strategies to improve Mr T's communication skills in these specific contexts, such as
practicing communication techniques relevant to playing hockey or engaging in group conversations.
It may also be important to address any emotional or psychological challenges that may arise from
potential limitations in participating in these activities, such as feelings of frustration,
embarrassment, or social withdrawal.
Overall, the activity and participation challenges that Mr T may experience following discharge home
include difficulties in his work, social interactions, and leisure activities. Addressing these challenges
will require a comprehensive approach that focuses on improving Mr T's speech production and
comprehension skills, providing education and support to his partner and support network, and
addressing any emotional or psychological impacts that may arise. By targeting these specific areas
of difficulty, the intervention can help Mr T regain his communication skills and enhance his overall
quality of life.
https://www.asha.org/practice-portal/clinical-topics/acquired-apraxia-of-speech/#collapse_6
Goals and treatment
Primary Goal:
The primary goal for this client may be to improve speech intelligibility and communication
effectiveness. This goal addresses the client's main difficulty in producing clear and understandable
speech, which affects his ability to engage in conversations and express his thoughts and needs.
Secondary Goal:
The secondary goal for this client may be to improve the client's ability to follow complex
instructions. This goal addresses the client's difficulty in understanding and processing more complex
language tasks, which may hinder his ability to participate fully in activities and conversations.
Treatment Approach for the Primary Goal:
One possible treatment approach for addressing the primary goal of improving speech intelligibility
and communication effectiveness in this client is the use of a multi-modal treatment approach,
specifically the PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) technique. The
PROMPT technique focuses on facilitating the correct movement and coordination of the articulatory
structures involved in speech production.
Reasoning:
The PROMPT technique is a widely used treatment approach for motor speech disorders, including
Apraxia of Speech (AOS). It provides tactile-kinesthetic cues to the articulators, helping individuals to
plan and execute accurate speech movements. This approach is particularly suitable for clients with
AOS who have difficulty initiating and sequencing speech movements.
In the case of Mr T, his effortful speech, production errors, and inconsistent speech patterns indicate
a possible diagnosis of AOS. The PROMPT technique can help facilitate the coordination and
sequencing of speech movements, improving speech clarity and intelligibility.
By using tactile-kinesthetic cues, the speech pathologist can provide feedback and support to Mr T
during speech production. The therapist can guide and shape his articulatory movements using their
hands, placing gentle pressure on the articulators to ensure accurate placement and movement. This
technique encourages the client to become more aware of their speech movements, improve motor
planning, and produce more intelligible speech.
The PROMPT technique is a dynamic and individualized approach that can be tailored to the client's
specific needs and speech patterns. It can be used in conjunction with other treatment techniques or
activities to address the client's overall communication goals.
Overall, the PROMPT technique is a suitable treatment approach for Mr T to address his primary goal
of improving speech intelligibility and communication effectiveness. It targets the underlying motor
planning and coordination difficulties associated with AOS, providing the necessary support and
feedback to facilitate the production of clear and understandable speech. Secondary Goal
The secondary goal for this client may be to improve the client's ability to follow complex
instructions. This goal addresses the client's difficulty in understanding and processing more complex
language tasks, which may hinder his ability to participate fully in activities and conversations.
Treatment Approach for the Secondary Goal:
One possible treatment approach for addressing the secondary goal of improving the client's ability
to follow complex instructions is the use of a hierarchical task analysis approach. This approach
involves breaking down complex instructions into smaller, more manageable steps, and gradually
increasing the complexity as the client progresses.
Reasoning:
A hierarchical task analysis approach is a suitable treatment approach for addressing the client's
difficulty in following complex instructions. By breaking down complex instructions into smaller
steps, the therapist can provide the client with a more structured and manageable approach to
processing and understanding the instructions.
Initially, the therapist can start with simple and familiar instructions and gradually increase the
complexity over time. The therapist can use visual aids, such as written or illustrated instructions, to
support the client's understanding and processing of the instructions.
This approach allows the client to build their comprehension skills gradually and systematically,
giving them the opportunity to practice and develop their ability to understand and follow more
complex instructions. It also provides a clear and predictable structure for the client to follow,
reducing the cognitive load and increasing their chances of successful comprehension and
implementation of the instructions.
Additionally, the therapist can incorporate repetition and rehearsal of the instructions to further
reinforce understanding and retention. This can be done through various activities, such as role-
playing, interactive games, and real-life scenarios that require following complex instructions.
By using a hierarchical task analysis approach, the therapist can address the client's difficulty in
following complex instructions and improve their ability to understand and participate in activities
and conversations that involve more intricate language tasks. This approach provides a systematic
and structured framework for the client to develop their comprehension skills and gradually work
towards their communication goals.
-
https://www.asha.org/practice-portal/clinical-topics/acquired-apraxia-of-speech/#collapse_6
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