Speech Practice

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Classification according to ICD-10
R48.2 Apraxia
ICD-10 online (WHO version 2019)

The apraxia of speech ( English Apraxia of Speech , in short: AOS ) is defined as a disorder of speech motor programming processes. This neurologically caused, acquired cerebral speech disorder is usually caused by infarcts of the left middle cerebral artery. Speech apraxia usually goes hand in hand with aphasia , especially Broca's aphasia . Isolated speech apraxia is rarely observed.

Due to the lesion in the area of ​​the cerebral hemisphere, in which the speech-dominant areas are located, disorders of the speech-motor functions result. This disturbance of the speech-motor programming processes can be seen both when checking voluntary movements and when checking spontaneous speech. The areas of perception and processing of language are not disturbed during speaking practice.

If one considers speech apraxia in language processing models, it is located between aphasia , a language systematic disorder, and dysarthria , a disorder of motor execution.

Speech apraxia is characterized by prosodic impairments, such as an extended duration of consonants and vowels as well as pauses between sounds , syllables and words . The dominant symptoms are phonetic errors (breathing on, detuning, sound stretching, nasalization, relocation and over-aspiration), so that the phonetic encoding is disturbed, whereas phonological errors occur less frequently.

Because of their awareness of the disorder and their intact understanding of the language, those affected show great frustration with the acquired unnecessary manner of speaking and the disturbed sound structure in linguistic utterances.

causes

Speech practices can be triggered by various causes. However, it is always a more or less irreversible destruction of brain tissue.

They are considered acquired, neurogenic speech disorders, which are usually caused by an insult or a traumatic brain injury . According to information in the literature, an isolated speech apraxia, without combination with another disorder, occurs in only about 10 percent of patients. Most of these patients also suffer from aphasia. Since speech apraxia rarely occurs as an isolated disorder and the neural networks are very complex, no reliable assignment to lesion locations can be established. There is evidence of medial infarction in the left hemisphere, as well as lesions of the islet cortex, medullary bed, and subcortical disorders may be a possible cause.

According to the literature, speaking practice, regardless of handedness, is the result of a left-sided lesion in the supply area of ​​the A. cerebri media. It is less common for cerebral tumors or inflammatory processes to lead to speech apraxia.

Symptoms

The symptoms of speech apraxia include initiation problems, phonetic distortions and intonational abnormalities and search movements. In severe forms of speech apraxia, the voluntary formation of sounds itself can be disturbed, the patients can then not even consciously phoning, while the reflex sound generation, for example when laughing, is intact.

Overall, it is more of a pure “output disorder”. The functions of reading, writing and language comprehension are completely intact in a pure speech practice. There is also no disruption of muscle strength. Dysarthria is often present at the same time .

Practical speech symptoms can show up on different levels:

1.) On the segmental level: Disturbances on this level relate to the individual speech sounds. It comes to:

· Phonematic errors: sound delusions, additions and substitutions

Distorted phonematic errors: a sound is changed and stretched at the same time

Phonetic distortions: sound stretching, labialization, (de-), nasalization

· Disturbed sound transitions

· Inconsistency of the error pattern: The patient does not show any uniform errors. Sounds can be formed differently at different times.

Disturbance-free intervals: patients can articulate partially without disturbance despite moderate to severe speech apraxis.

2.) On the suprasegmental level: Disturbances on this level affect the prosodic elements of speech. It comes to:

· Slower speaking speed

· Syllabic speaking

· Breaks in the flow of speech

· Inappropriate breaks

· Long pauses in speaking

· Iteration of sounds, syllables and / or words    

3.) At the level of speaking behavior: It comes to:

· Visible and audible speech effort

· Silent or audible search movements

· Visible frustration

Diagnosis

For a logopedic or clinical-linguistic diagnosis, there are criteria that indicate the presence of a speech apraxia.

The aim of diagnostics is to identify speech practice and to differentiate it from other disorders.

There is still no standardized test procedure for speaking practice in the German-speaking area. A combination of different examinations is therefore recommended. With the help of the 10-point checklist by Liepold et al. (2003), the possible existence of a speaking practice can be checked. Here 10 questions are answered with “yes” or “no” - the more questions are answered with “yes”, the greater the probability that a speaking practice is present. If there is a suspicion of speaking practice, further diagnostics should be carried out. In terms of differential diagnosis, it is primarily necessary to differentiate speech apraxia from the disorders of dysarthria and aphasia.

Perceptual procedures

Visually and aurally recognizable symptoms are evaluated. The perceptual methods include the analysis of the spontaneous speech and communication skills of those affected, comprehensibility measurements and examination forms such as those from Lauer & Birner-Janusch (2010) or the hierarchical word lists from Liepold et al. These systemic examination procedures also enable progress monitoring.

Apparatus procedures

Apparatus methods enable an objective examination of the symptoms. However, this is usually only possible in larger hospitals.

Hierarchical word lists

Hierarchical word lists are a screening process that is used to assess the severity and focus of the disorder. It is a follow-up test in which the patient should repeat the words / pseudo-words or read them out loud if necessary. The aim of the screening is the systematic recording of practical speaking symptoms. The test method includes words and pseudo-words in order to be able to assess the lexicality, different word lengths in order to determine word length effects, as well as simple and complex syllable structures in order to determine the syllable complexity. The screening consists of 2 × 8 lists. These lists consist of 6 words and pseudo-words each, whereby the items in each list have the same number and structure of syllables. The screening items are arranged in categories with an increasing number of syllables. If at least three errors or unusable reactions occur in three consecutive periods, the test is terminated.

literature

  • Norina Lauer, Beate Birner-Janusch: Speech practice in childhood and adulthood. Thieme, Stuttgart 2010, ISBN 3-13-142452-4 .
  • Maria Geissler: Speech practice: a guide for those affected and their relatives. Schulz-Kirchner, 2005, ISBN 3-8248-0384-4 .

Web links

Individual evidence

  1. ↑ Alphabetical directory for the ICD-10-WHO version 2019, volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 933
  2. ↑ a b c d e f g h i j k l m n Norina Lauer, Beate Birner-Janusch: Speech apraxia in childhood and adulthood . Ed .: Luise Springer, Dietlinde Schrey-Dern. 2nd Edition. Georg Thieme, Stuttgart 2010, ISBN 978-3-13-142452-5 .
  3. ↑ a b c d e f Michaela Liepold, Wolfram Ziegler, Bettina Brendel: EKN materials for rehabilitation. Hierarchical word lists. A follow-up test for language practice diagnostics. tape 13 . borgmann publishing GmbH, 2010.
  4. ↑ Wolfram Ziegler: Speech Practice: Concepts and Controversies . In: aphasie suisse (ed.): Aphasia and related areas . tape 25 . Swiss Working Group for Aphasia, Lucerne January 2010.
  5. ↑ Karen Lorenz: Speech Practice in Adults . In: Manfred Grohnfeldt (ed.): Compendium of academic speech therapy and speech therapy . tape 4 . Kohlhammer, Stuttgart, p. 165 ff .
  6. ↑ B. Schneider, M.Wehmeyer, H. Grötzbach: demarcation of aphasia to other communicative impairments . In: Barbara Schneider, Meike Wehmeyer (Ed.): Aphasia . 6th edition. Springer, Berlin, p. 54 .
  7. ↑ Norina Lauer, Beate Birner-Janusch: Speech practice in childhood and adulthood . Ed .: Luise Springer, Dietlinde Schrey-Dern. 2nd Edition. Stuttgart.
  8. ↑ McNeil, MR, Robin, DA & Schmidt, RA: Apraxia of Speech: definition, differentiation and treatment. In: McNeil, MR (Ed.): Clinical Management of Sensorimotor Speech Disorders. Thieme, New York 1997, p. 311-344 (English).
  9. ↑ Speaking practice ( memento of the original from June 7, 2008 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. - Definition of a speech disorder @1@ 2Template: Webachiv / IABot / www.logopaedie-bachus.de
  10. ↑ Speaking practice ( memento of the original from March 5, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. - Overview flyer (pdf; 54 kB) @1@ 2Template: Webachiv / IABot / www.logopaedie-gl.de
  11. ↑ Norina Lauer & Beate Birner-Janush: Speech practice in childhood and adulthood . Ed .: Forum Logopädie. 2nd Edition. Thieme, Stuttgart 2010, p. 17 .
  12. ↑ Julia Siegmüller & Henrik Bartels: Guide Language Speaking Voice Swallowing . Ed .: Henrik Bartels. 5th edition. Elsevier, Munich 2010, p. 291 .
  13. ↑ Julia Siegmüller & Henrik Bartels: Guide Language Speaking Voice Swallowing . Ed .: Henrik Bartels. 5th edition. Elsevier, Munich 2017, p. 292 .
  14. ^ Liepold, M., Ziegler, W. & Brendel, B .: Hierarchical word lists. A follow-up test for speech practice diagnostics. 2003.
  15. ↑ a b c d e Norina Lauer, Beate Berner-Janusch: Speech apraxia in childhood and adulthood . Thieme, Stuttgart 2010, p. 32 .
  16. ↑ Anja Staiger, Theresa Schölderle, Bettina Brendel & Wolfram Ziegler: Neurogenic Speech Disorders . In: Julia Siegmüller & Henrik Bartels (Eds.): Guide Language Speaking Voice Swallowing . 5th ed. Elsevier, p. 281-302 .
  17. ↑ Liepold et al. (quoted from Lauer & Birner-Janusch): 10-point checklist for the presence of a speaking practice . In: Norina Lauer & Beate Birner-Janusch (eds.): Speech apraxia in childhood and adulthood . 2nd edition Thieme, Stuttgart 2010, p. 26 .
  18. ↑ a b Michaela Liepold, Wolfram Ziegler, Bettina Brendel: EKN materials for rehabilitation. Hierarchical word lists. A follow-up test for speech practice diagnostics . tape 13 . Borgmann, S. 15 .