Recovering With Acquired Apraxia of Speech: The First 2 Years

Purpose This study was intended to document speech recovery for 1 person with acquired apraxia of speech quantitatively and on the basis of her lived experience. Method The second author sustained a traumatic brain injury that resulted in acquired apraxia of speech. Over a 2-year period, she documented her recovery through 22 video-recorded monologues. We analyzed these monologues using a combination of auditory perceptual, acoustic, and qualitative methods. Results Recovery was evident for all quantitative variables examined. For speech sound production, the recovery was most prominent during the first 3 months, but slower improvement was evident for many months. Measures of speaking rate, fluency, and prosody changed more gradually throughout the entire period. A qualitative analysis of topics addressed in the monologues was consistent with the quantitative speech recovery and indicated a subjective dynamic relationship between accuracy and rate, an observation that several factors made speech sound production variable, and a persisting need for cognitive effort while speaking. Conclusions Speech features improved over an extended time, but the recovery trajectories differed, indicating dynamic reorganization of the underlying speech production system. The relationship among speech dimensions should be examined in other cases and in population samples. The combination of quantitative and qualitative analysis methods offers advantages for understanding clinically relevant aspects of recovery.

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Perceptually Salient Sound Distortions and Apraxia of Speech: A Performance Continuum

American Journal of Speech-Language Pathology ◽

10.1044/2017_ajslp-16-0103 ◽

2017 ◽

Vol 26 (2S) ◽

pp. 631-640 ◽

Cited By ~ 9

Author(s):

Katarina L. Haley ◽

Adam Jacks ◽

Jessica D. Richardson ◽

Julie L. Wambaugh

Keyword(s):

Left Hemisphere ◽

Sound Production ◽

Dynamic Performance ◽

Speech Sound ◽

Speaking Rate ◽

Apraxia Of Speech ◽

External Criterion ◽

Syllable Duration ◽

Left Hemisphere Stroke ◽

A Performance

Purpose We sought to characterize articulatory distortions in apraxia of speech and aphasia with phonemic paraphasia and to evaluate the diagnostic validity of error frequency of distortion and distorted substitution in differentiating between these disorders. Method Study participants were 66 people with speech sound production difficulties after left-hemisphere stroke or trauma. They were divided into 2 groups on the basis of word syllable duration, which served as an external criterion for speaking rate in multisyllabic words and an index of likely speech diagnosis. Narrow phonetic transcriptions were completed for audio-recorded clinical motor speech evaluations, using 29 diacritic marks. Results Partial voicing and altered vowel tongue placement were common in both groups, and changes in consonant manner and place were also observed. The group with longer word syllable duration produced significantly more distortion and distorted-substitution errors than did the group with shorter word syllable duration, but variations were distributed on a performance continuum that overlapped substantially between groups. Conclusions Segment distortions in focal left-hemisphere lesions can be captured with a customized set of diacritic marks. Frequencies of distortions and distorted substitutions are valid diagnostic criteria for apraxia of speech, but further development of quantitative criteria and dynamic performance profiles is necessary for clinical utility.

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Auditory-Perceptual Speech Features in Children With Down Syndrome

American Journal on Intellectual and Developmental Disabilities ◽

10.1352/1944-7558-124.4.324 ◽

2019 ◽

Vol 124 (4) ◽

pp. 324-338 ◽

Cited By ~ 1

Author(s):

Harrison N. Jones ◽

Kelly D. Crisp ◽

Maragatha Kuchibhatla ◽

Leslie Mahler ◽

Thomas Risoli ◽

...

Keyword(s):

Down Syndrome ◽

Sound Production ◽

Speech Rate ◽

Speech Sound ◽

Speech Disorders ◽

Future Research ◽

Assessment And Treatment ◽

Pitch Level ◽

Loudness Level ◽

Speech Features

Abstract Speech disorders occur commonly in individuals with Down syndrome (DS), although data regarding the auditory-perceptual speech features are limited. This descriptive study assessed 47 perceptual speech features during connected speech samples in 26 children with DS. The most severely affected speech features were: naturalness, imprecise consonants, hyponasality, speech rate, inappropriate silences, irregular vowels, prolonged intervals, overall loudness level, pitch level, aberrant oropharyngeal resonance, hoarse voice, reduced stress, and prolonged phonemes. These findings suggest that speech disorders in DS are due to distributed impairments involving voice, speech sound production, fluency, resonance, and prosody. These data contribute to the development of a profile of impairments in speakers with DS to guide future research and inform clinical assessment and treatment.

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Language Skill Mediates the Relationship Between Language Load and Articulatory Variability in Children With Language and Speech Sound Disorders

Journal of Speech Language and Hearing Research ◽

10.1044/2018_jslhr-l-18-0055 ◽

2018 ◽

Vol 61 (12) ◽

pp. 3010-3022 ◽

Cited By ~ 7

Author(s):

Janet Vuolo ◽

Lisa Goffman

Keyword(s):

Language Impairment ◽

Specific Language Impairment ◽

Language Disorder ◽

Speech Sound ◽

Apraxia Of Speech ◽

Speech Sound Disorders ◽

Speech Sound Disorder ◽

Childhood Apraxia Of Speech ◽

Retrieval Task ◽

The Relationship

Purpose The aim of the study was to investigate the relationship between language load and articulatory variability in children with language and speech sound disorders, including childhood apraxia of speech. Method Forty-six children, ages 48–92 months, participated in the current study, including children with speech sound disorder, developmental language disorder (aka specific language impairment), childhood apraxia of speech, and typical development. Children imitated (low language load task) then retrieved (high language load task) agent + action phrases. Articulatory variability was quantified using speech kinematics. We assessed language status and speech status (typical vs. impaired) in relation to articulatory variability. Results All children showed increased articulatory variability in the retrieval task compared with the imitation task. However, only children with language impairment showed a disproportionate increase in articulatory variability in the retrieval task relative to peers with typical language skills. Conclusion Higher-level language processes affect lower-level speech motor control processes, and this relationship appears to be more strongly mediated by language than speech skill.

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Predicting Intelligibility: An Investigation of Speech Sound Accuracy in Childhood Apraxia of Speech

CommonHealth ◽

10.15367/ch.v1i2.397 ◽

2020 ◽

Vol 1 (2) ◽

pp. 44-56

Author(s):

Kyra Skoog ◽

Edwin Maas

Keyword(s):

Speech Sound ◽

Primary Outcome Measure ◽

Apraxia Of Speech ◽

Childhood Apraxia Of Speech ◽

Treatment Research ◽

Speech Accuracy ◽

Communicative Success ◽

Listening Experiment ◽

The Impact ◽

The Relationship

Background: Childhood apraxia of speech (CAS) is a pediatric speech disorder that significantly affects communication and life participation. Most CAS treatment research uses speech accuracy as primary outcome measure, on the assumption that accuracy predicts communicative success. However, this relationship has not yet been examined in this population, limiting our understanding of the impact of available treatments. Purpose: The purpose of this study is to explore the relationship between speech accuracy and intelligibility in children with CAS. Intelligibility is defined here as the proportion of words correctly understood by an unfamiliar listener. Methods: Adult listeners, who were unfamiliar with children with CAS, listened to recordings of children with CAS producing single words, and typed what they heard the child say. Separately, and prior to the listening experiment, the children’s words were scored for accuracy using various measures, including the percent phonemes (sounds) correct (PPC), percent consonants correct (PCC), and percent vowels correct (PVC). The relationship between these accuracy measures and intelligibility were examined descriptively. Results: Preliminary findings suggest that there is a positive relationship between intelligibility and PPC and PCC in children with CAS. Conclusions: Implications of these findings for clinical practice as well as future treatment research are discussed.

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Feature-driven classification reveals potential comorbid subtypes within childhood apraxia of speech

10.21203/rs.2.22862/v2 ◽

2020 ◽

Author(s):

Catherine Stein ◽

Penelope Benchek ◽

Gabrielle Miller ◽

Noémi B. Hall ◽

Dhanya Menon ◽

...

Keyword(s):

Sound Production ◽

Neurodevelopmental Disorder ◽

Speech Sound ◽

Hierarchical Cluster ◽

Educational Interventions ◽

Apraxia Of Speech ◽

Childhood Apraxia Of Speech ◽

Poor Reading ◽

Word Repetition ◽

Reading Measures

Abstract Background Childhood apraxia of speech (CAS) is a neurodevelopmental disorder with heterogeneous communication and other comorbid manifestations. While previous studies have characterized speech deficits associated with CAS, few studies have examined variability in reading and language and/or other developmental comorbidities. We sought to identify comorbid subgroups within CAS that could be clinically relevant as well as genetically distinctive. Methods In a group of 31 children with CAS and 8 controls, we performed hierarchical cluster analysis utilizing measures of articulation, vocabulary, and reading. We also conducted a chart review of the children with CAS to examine other clinical characteristics in these children and their association with subgroup membership. Results We identified 3 comorbid subgroups within CAS of varying severity. The high severity subgroup was characterized by poor reading and vocabulary, and the moderate severity subgroup by poor reading and non-word repetition but average vocabulary, compared to the mild severity subgroup. Subgroups were indistinguishable with respect to speech sound production, the hallmark of CAS, all demonstrating poor articulation. Children in the most severe subgroup were more likely to have early problems feeding (p=0.036). Conclusions Children with CAS may potentially be classified into comorbidity groups based on performance on vocabulary and reading measures, providing additional insight into the heterogeneity within CAS with implications for educational interventions.

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Differences Between School-Age Children With Apraxia of Speech and Other Speech Sound Disorders on Multisyllable Repetition

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-19-00086 ◽

2020 ◽

Vol 5 (4) ◽

pp. 794-808 ◽

Cited By ~ 1

Author(s):

Nina R. Benway ◽

Jonathan L. Preston

Keyword(s):

Speech Sound ◽

Previous Literature ◽

School Age Children ◽

School Age ◽

Apraxia Of Speech ◽

Speech Sound Disorders ◽

Childhood Apraxia Of Speech ◽

Speech Corpus ◽

Word Structure ◽

Speech Features

Purpose The aim of the study was to evaluate whether features of childhood apraxia of speech (CAS) identified in previous literature could be replicated in a sample of school-age children. Method A literature review was conducted to identify candidate speech features that have been previously considered when differentiating CAS from other types of speech sound disorders (SSDs). The candidate features recoverable from blinded transcriptions of multisyllable word repetitions (MSWRs) were applied to a cohort of 61 children aged 7–17 years, previously classified as having CAS ( n = 21) or non-CAS SSD ( n = 40). Results One hundred and ninety-four features had been explored in previous literature to assess their ability to differentiate CAS from other SSDs. Fifteen perceptual features were selected from this list to be applied to performance on the MSWR. In this sample, children with CAS differed from children with SSD on the prevalence of voicing changes, percentage of structurally correct words, correct lexical stress, and syllable deletions within a speech corpus derived from the MSWR task. Conclusion Although previous literature points to numerous features as differentiating CAS from other SSDs, only a portion of those features were replicated in this sample of school-age children. Features of CAS that affect segmental accuracy, prosody, and word structure may be likely to persist into late childhood and early adolescence.

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Clarifying the Relationship Between Early Speech-Sound Production Abilities and Subsequent Reading Outcomes

10.31219/osf.io/zx2k3 ◽

2021 ◽

Author(s):

Marjolein Mues ◽

Jennifer Zuk ◽

Elizabeth Norton ◽

John Gabrieli ◽

Tiffany P. Hogan ◽

...

Keyword(s):

Oral Language ◽

Sound Production ◽

Word Reading ◽

Speech Sound ◽

Reading Difficulties ◽

Literacy Skills ◽

Reading Outcomes ◽

Speech Accuracy ◽

The Relationship ◽

Production Accuracy

Purpose: Learning to read is a complex, multi-faceted process that relies on several speech and language-related subskills. Individual differences in word reading outcomes are indicated among children with inaccurate speech-sound productions, with inconsistent reports as to whether phonological deficits and/or weaknesses in oral language explain subsequent reading difficulties. Thus, it remains unclear how variability in speech production accuracy in early childhood may impact reading development. Therefore, the present longitudinal study seeks to clarify the relationship between speech-sound production accuracy in kindergarten and subsequent reading outcomes with a focus on additional potential mediating factors.Method: Speech accuracy, core pre-literacy skills (phonological awareness, rapid naming, letter-name knowledge) and additional potential mediators (oral language, nonverbal cognitive abilities, and socioeconomic status (SES) were characterized at the start of formal reading instruction. Word reading, decoding, reading fluency and comprehension were assessed at the end of second grade. Mediation analyses were conducted to examine factors that mediate the relationship between speech accuracy in kindergarten and subsequent reading outcomes.Results: Speech-sound production accuracy uniquely contributed to the prediction of word reading; whereas full mediation effects of core pre-literacy skills and SES were identified for decoding and fluency. For reading comprehension, full effects of pre-literacy and vocabulary skills were observed. Hierarchical regression models further revealed the relative contributions of each factor to respective reading outcomes.Conclusions: Findings carry implications for the importance of monitoring emergent literacy abilities among children with speech delays and assessing speech-sound production accuracy in multifactorial approaches to early identification of risk for reading difficulties.

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Feature-driven classification reveals potential comorbid subtypes within childhood apraxia of speech

10.21203/rs.2.22862/v3 ◽

2020 ◽

Author(s):

Catherine Stein ◽

Penelope Benchek ◽

Gabrielle Miller ◽

Noémi B. Hall ◽

Dhanya Menon ◽

...

Keyword(s):

Sound Production ◽

Neurodevelopmental Disorder ◽

Speech Sound ◽

Hierarchical Cluster ◽

Educational Interventions ◽

Apraxia Of Speech ◽

Childhood Apraxia Of Speech ◽

Poor Reading ◽

Word Repetition ◽

Reading Measures

Abstract Background: Childhood apraxia of speech (CAS) is a neurodevelopmental disorder with heterogeneous communication and other comorbid manifestations. While previous studies have characterized speech deficits associated with CAS, few studies have examined variability in reading and language and/or other developmental comorbidities. We sought to identify comorbid subgroups within CAS that could be clinically relevant as well as genetically distinctive. Methods: In a group of 31 children with CAS and 8 controls, we performed hierarchical cluster analysis utilizing measures of articulation, vocabulary, and reading. We also conducted a chart review of the children with CAS to examine other clinical characteristics in these children and their association with subgroup membership. Results: We identified 3 comorbid subgroups within CAS of varying severity. The high severity subgroup was characterized by poor reading and vocabulary, and the moderate severity subgroup by poor reading and non-word repetition but average vocabulary, compared to the mild severity subgroup. Subgroups were indistinguishable with respect to speech sound production, the hallmark of CAS, all demonstrating poor articulation. Children in the most severe subgroup were more likely to have early problems feeding (p=0.036). Conclusions: Children with CAS may potentially be classified into comorbidity groups based on performance on vocabulary and reading measures, providing additional insight into the heterogeneity within CAS with implications for educational interventions.

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Pure Apraxia of Speech After Resection Based in the Posterior Middle Frontal Gyrus

Neurosurgery ◽

10.1093/neuros/nyaa002 ◽

2020 ◽

Vol 87 (3) ◽

pp. E383-E389 ◽

Cited By ~ 1

Author(s):

Edward F Chang ◽

Garret Kurteff ◽

John P Andrews ◽

Robert G Briggs ◽

Andrew K Conner ◽

...

Keyword(s):

Sound Production ◽

Premotor Cortex ◽

Speech Sound ◽

Middle Frontal Gyrus ◽

Apraxia Of Speech ◽

Imaging Data ◽

Dorsal Premotor Cortex ◽

Human Connectome Project ◽

Language Area ◽

Classical Language

Abstract BACKGROUND AND IMPORTANCE Apraxia of speech is a disorder of articulatory coordination and planning in speech sound production. Its diagnosis is based on deficits in articulation, prosody, and fluency. It is often described concurrent with aphasia or dysarthria, while pure apraxia of speech is a rare entity. CLINICAL PRESENTATION A right-handed man underwent focal surgical resection of a recurrent grade III astrocytoma in the left hemisphere dorsal premotor cortex located in the posterior middle frontal gyrus. After the procedure, he experienced significant long-term speech production difficulties. A battery of standard and custom language and articulatory assessments were administered, revealing intact comprehension and naming abilities, and preserved strength in orofacial articulators, but considerable deficits in articulatory coordination, fluency, and prosody—consistent with diagnosis of pure apraxia of speech. Tractography and resection volumes compared with publicly available imaging data from the Human Connectome Project suggest possible overlap with area 55b, an under-recognized language area in the dorsal premotor cortex and has white matter connectivity with the superior longitudinal fasciculus. CONCLUSION The case reported here details a rare clinical entity, pure apraxia of speech resulting from resection of posterior middle frontal gyrus. While not a classical language area, emerging literature supports the role of this area in the production of fluent speech, and has implications for surgical planning and the general neurobiology of language.

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