Apraxia

1
Apraxia

• Considered as dyspraxia (separate from dysphasia
  / aphasia)
• Considered as one of the problems in case of
  afferent motor aphasia (A. Luria)

2
Case 1

• 27 y.o female.
• Stroke in the left hemispere following a heart
  surgery
• Was admitted to the rehabilitation ward at the
  Gold Coast Hospital a week later
• Started having speech pathology intervention 5
  days a week two times a day

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Case 1

• She only used gestures and pointing to
  communicate
• Was not able to consistently answer yes and no
  questions
• She also had trouble with comprehension and
  written language

4
Case 1 word lists

• Apraxia drills proved to be very useful!
• 1. Word lists. E.g. pie, pay, pea, pat, poke,
  pick, pack, peek, prime, pace, paid, pair, pam,
  pass, peg, peel, poor, pyre, pet, past, play,
  place, play, plant, praise, prank, prawn, pray,
  price, practice, predict, printer, precise,
  prattle...
• We mostly used repetition. Visual help only
  if necessary.

5
Case 1 rhyming series

• 2. Rhyming series. E.g. he me pea bee we
  tea d knee lee re key ghee fee
  v thee see she tree free flea ski
  glee three...
• We mostly used repetition, later on reading
  as well. Again, visual help the last option.

6
Case 1 Word pairs

• 3. Word pairs. E.g. Pair contrasts voice vs.
  unvoiced bee pea, bay pay, beach peach,
  ben pen, dogs togs, door tore, guilt
  kilt, gave cave, zoo sue, zinc sink, vocal
  focal, vigor figure.
• We started with immediate repetition. Moving
  on to work on the work memory, using repetition
  with a delay. Building the delay up to 10 sec.
  

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Case 1 - results

• Within two weeks of speech pathology intervention
  and these apraxia drills the patients speech was
  a lot more fluent and the problems with her
  speech were almost unnoticeable. Her language
  skills were slowly improving as well.

8
Case 2

• 82 y.o female
• Stroke in the left hemisphere of the brain
• She was admitted to rehab. in East-Tallinn
  Central Hospital a month after the stroke.
• Started having speech therapy 5 times a week

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Case 2

• She was only able to use one word utterances,
  which were distorted too
• She was not able to consistently answer yes and
  no questions, mostly due to apraxia
• Her language comprehension was good
• She had some problems with written language as
  well.

10
Case 2 word lists

• Apraxia drills proved to be very useful again!
• 1. Word lists. E.g. Kana, kiri, koer, karu, kass,
  kari, kare, kiisu, kord, kisa, kaart, kübar,
  kärme, kuld, koi, küla, kükk, kõik, käik, külm,
  kõva, kera, kivi, kurb, kell, kink, kild, kiisk,
  kurss, korv, käsi, küsi, kuut, köha, kohv, kukk,
  kapp, koot, kulm...
• We mostly used repetition. Reading and visual
  help only if necessary.

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Case 2 Rhyming series

• 2. Rhyming series. E.g. vool tool kool mool
  pool sool nool hool rool lool...
• We mostly used repetition and reading.
  Visual help if needed.

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Case 2 Word pairs

• 3. Word pairs. E.g. voiced vs. unvoiced initial
  labial sounds põlv-võlv, pere-veri, parm-varb,
  pesa-visa, pihk-viht, pala-vala, pilu-vilu,
  pärg-märg, pilk-mürk, puus-muus, panna-manna,
  pass-mass, püri-muri...
• We used mostly repetition (immediate rep. To
  start with). Reading and visual help if needed.
  Moving on to work on the work memory, using
  repetition with a delay. Building the delay up to
  10 sec. The patient achieved this pretty easily.

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Case 2 - Results

• The patient spent only 2 weeks in rehabilitation
  and was then sent home.
• Her language improved to a level where she could
  express most of her thoughts, but she was still
  struggling a bit due to apraxia and mild
  expressive aphasia.
• She spend another 10 days in rehab. 3 months
  later, but the speech pathology intervention did
  not have as much effect then.

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Some thoughts and points noted!

• If a word does not have a meaning, it is a lot
  harder to say in case of apraxia.
• Visual help (seeing another person saying the
  same word) is like a way of escaping the apraxia.
  Patients like to take advantage of it, but it
  does not help them to get over apraxia in longer
  terms.
• The drills can be very frustrating and might seem
  pointless to a patient, but on my experience they
  really have proven to be useful and help patients
  get over apraxia.