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

3. 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.

7. Case 1 - results • Within two weeks of speech pathology intervention and these apraxia drills the patient´s 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

9. 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.

11. 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.

12. 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.

13. 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.

14. 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.