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A Sub-Acute Case of Resolving Acquired Apraxia of Speech and Aphasia Shannon C

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A Sub-Acute Case of Resolving Acquired Apraxia of Speech and Aphasia Shannon C hysical M f P ed l o ic a in n r e u & o R J International Journal of Physical l e a h n a o b i Mauszycki et al., Int J Phys Med Rehabil 2014, 2:2 t i l a ISSN: 2329-9096i t a n r t i e o t n 10.4172/2329-9096.1000188 n I Medicine & Rehabilitation DOI: Research Article Open Access A Sub-Acute Case of Resolving Acquired Apraxia of Speech and Aphasia Shannon C. Mauszycki1,2*, Sandra Wright1 and Julie L. Wambaugh1,2 ¹VA Salt Lake City Healthcare System, Salt Lake City, UT, USA ²University of Utah, Salt Lake City, UT, USA *Corresponding author: Shannon C. Mauszycki, Aphasia/Apraxia Research Lab, 151-A, Building 2, 500 Foothill Drive, Salt Lake City, UT 84148, USA, Tel: 801-582-1565, Ext: 2182; Fax: 801-584-5621; E-mail: [email protected] Rec date: 20 Feb 2014; Acc date:21 March 2014; Pub date: 23 March 2014 Copyright: © 2014 Mauszycki SC, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Apraxia of speech (AOS) is a neurogenic, motor speech disorder that disrupts the planning for speech production. However, there are only a few reports that have described the evolution of stroke-induced AOS symptoms in the acute or sub-acute phase of recovery. The purpose of this report was to provide a data-based description of an individual with sub-acute AOS and aphasia followed from 1 month post-onset a stroke to 8 months post-stroke. Six data collection sessions were conducted at periodic intervals using narrative and procedural discourse tasks and a series of speech and language analyses were completed. The language analyses involved measures of language content and efficiency. The speech production analyses examined the percentage and frequency of errors as well as determining the dominant types of errors produced within and across data collection sessions. For this individual, measures of language content and communication efficiency improved over the six sampling occasions. The number of speech production errors significantly declined after the first data collection session and then gradually over the subsequent sessions. This individual produced five dominant error types within and across sessions. The majority of these error types are behaviors that occur in chronic AOS, but do not distinguish AOS from other acquired neurogenic communication disorders. Due to the lack of research involving acute/sub-acute individuals with AOS additional research is warranted to better understand the evolution of AOS including the speech behaviors that are observed in the acute/sub-acute phase vs. the chronic phase of recovery. Keywords: Apraxia of speech; Aphasia; Treatment; Neurogenic Stroke is the most common etiology for AOS [1]. Damage to communication disorders; Speech; Language cortical and/or subcortical areas of the language dominant hemisphere have been associated with AOS [4]. Debates concerning the specific Introduction brain regions implicated in AOS remain unresolved [5-7]. AOS has also been found with neurodegenerative disease (i.e., primary Stroke-induced acquired apraxia of speech (AOS) is a neurogenic, progressive AOS) [8]. sensori-motor speech disorder. It is considered to be a disruption of the ability to plan or program the movements necessary for correct Treatment for acquired apraxia of speech (AOS) has taken articulation [1]. More specifically, AOS is not thought to be a disorder numerous forms, with positive outcomes reported for most treatments of language (e.g., aphasia); words and the sounds comprising those [9]. Following a critical evaluation and synthesis of the AOS treatment words are processed accurately. Instead, AOS reflects difficulties in literature, AOS treatment guideline developers concluded that “taken retrieving previously learned movement patterns needed to translate as a whole, the AOS treatment literature indicates that individuals with correctly selected sounds/syllables/words to articulated speech [2]. AOS may be expected to make improvements in speech production as Unlike dysarthria, there are no clinically evident impairments in a result of treatment, even when AOS is chronic” (p.lxii) [10]. The neuromuscular physiology. Although AOS is a unique clinical entity AOS guidelines developers grouped treatment studies by general that differs from aphasia and dysarthria, it can co-occur with both of focus: articulatory-kinematic, rate/rhythm control, intersystemic these other disorders. In particular, AOS rarely occurs without reorganization, and alternative/augmentative communication. The nonfluent aphasia. majority of evidence supporting AOS treatment has been derived from studies focused on treatments designed to improve articulation (i.e., AOS may range in severity from a complete inability to produce articulatory-kinematic therapies) [10,11]. speech to mild, infrequent sound distortions. The symptoms of AOS that are considered to be necessary for its diagnosis include slow rate The AOS treatment evidence-base has been predominated by of speech production, disrupted prosody, and sound errors that are studies of persons with chronic AOS. Of 146 participants in the AOS frequently distortions [3]. Symptoms that often occur with AOS, but guidelines report, approximately one-third were less than 6 months that do not differentiate it from other disorders include trial-and-error post-stroke [9]. In treatment efficacy reports, the majority of articulatory groping, sound and syllable repetitions, self-awareness of participants in the sub-acute phase have been described as having errors with attempts to correct, speech initiation difficulties, and severe AOS and their response to treatment has been overwhelmingly increased error rates associated with more complex utterances. positive. Approaches to treatment with non chronic AOS speakers Controversy continues regarding the relative consistency of error have been widely varied (e.g., gestural training, articulatory-kinematic location and error type in AOS [1]. treatment, environmental manipulation). Reports of treatment outcomes have typically been limited to post treatment changes in test Int J Phys Med Rehabil Stroke Rehabilitation ISSN:2329-9096 JPMR, an open access journal Citation: Mauszycki SC, Wright S, Wambaugh JL (2014) A Sub-Acute Case of Resolving Acquired Apraxia of Speech and Aphasia. Int J Phys Med Rehabil 2: 188. doi:10.4172/2329-9096.1000188 Page 2 of 6 scores. That is, treatment efficacy studies have provided relatively little Evaluation information concerning the progression of change in response to treatment with persons with non chronic AOS. The participant was referred to the Department of Veterans Affairs, Salt Lake City Health Care System’s Aphasia/Apraxia Research In the few reports that have focused on the evolution of stroke- Program at one month post stroke. The presence of AOS was induced AOS symptoms, investigators have noted the presence of determined using the diagnostic criteria described by McNeil et al. [2]. mutism in acute or early sub-acute AOS that resolved to less severe Speech samples were obtained employing the following elicitation AOS [12-14]. In these cases, persisting AOS symptoms included tasks: 1) Increasing Word Length, and Repeated Trials subtests of the initiation difficulties, articulatory errors, and dysprosody. These Apraxia Battery for Adults – 2nd Edition [15]; 2) narrative and reports provided largely anecdotal findings, with limited data. procedural discourse tasks [16]; 3) Assessment of Intelligibility of The purpose of the present report was to provide a data-based Dysarthric Speech (AIDs) [17]; 4) sentence repetition [18]; and 5) description of an individual with sub-acute AOS and aphasia followed multisyllabic word repetition [19]. The following behaviors deemed from one month post-onset a stroke to eight months post-onset with a necessary for the diagnosis of AOS were demonstrated by the course of treatment that primarily focused on AOS. participant: slow rate of speech production (including syllable segregation), sound errors that were relatively consistent in type and location across repeated trials. Method The participant received the diagnosis of anomic aphasia on the Participant basis of the Western Aphasia Battery-Revised (WAB-R) [20]. The participants’ productive verbal language primarily involved sentences A right-handed, 60 year-old Caucasian gentleman suffered a left that were broken up by language revisions and struggles with speech cerebral vascular accident in April of 2013. He was a native English production. The participant did not exhibit symptoms of dysarthria as speaker with 20 years of education. The gentleman was a physician described by Duffy [1]. and his daily work duties were comprised of evaluating and treating See Table 1 for assessment results at time of enrollment and patients, conducting clinical research trials as well as administrative subsequent intervals. During the time he was enrolled in the research responsibilities. program, he continued to receive outpatient speech services through He was administered tPA less than two hours after the onset of his the hospital outpatient program. Every effort was made not to stroke symptoms. The symptoms included right handed clumsiness duplicate treatment approaches between the hospital outpatient and an inability to produce speech prior to the arrival of emergency program and the research program. medical services. An MRI revealed
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