3. Describe the two main types of apraxia
a. Ideation apraxia: the loss of knowledge (conception) of how to make use of an object or gesture it’s function; uncommon disorder; damage to left parietal lobe; often resolves quickly
b. Ideomotor apraxia: a disturbance in the performance of the movements needed to use an object, make a gesture or complet a sequence of individual movments; Apraxia of speech is one of the ideomotor apraxias; a deficit in carrying out the motor plan needed to use the object or make a gesture.
4. What are the characteristics of pure ideomotor apraxia (pg 280)
a. Affects voluntary movements but not involuntary movement
b. Voluntary movements appear effortful and clumsy (groping movements)
c. Movement sequencing is easier when manipulating actual objects rather than pantomiming
d. Movement is easier when responding in imitation or with demonstration rather than when given a verbal direction
e. Errors are inconsistent, even with repeated attempts.
5. Describe the types of ideomotor apraxias
a. Limb apraxia: inability to sequence the movements of the arms, legs, hands, or feet during a voluntary action; left hemispheric damage
b. Non-verbal oral apraxia: buccofacial apraxia, facial apraxia, orofacial apraxia, lingual apraxia: inability to sequence nonverbal, voluntary movements of the tongue lips, jaw, and other oral structures: protruding the tongue, whistling, biting the lower lip and puffing out the cheeks; left hemisphere damage; often co-occurs with aphasia; does not affect spontaneous or reflexive orofacial movements
c. Apraxia of speech: verbal apraxia:  an inability to sequence the movements needed to produce phonemes for speech; and can co-occur with limb and oral paraxia; damage to the left frontal lobe near Broca’s area; rare to find pure aphasia; common to co-occur with unilateral UMN dysarthria.

6. What is the neurological basis for apraxia of speech?
a. To sequence speech many of the areas of the brain are involved in order to send a sequence of neural impulses that will contract the appropriate muscles at the correct time:
i. Language centers that provide linguistic information (phonemes)
ii. Basal ganglia, cerebellum, and thalamus that provide motor and sensory input about the planned speech movements
iii. Limbic system: emotional context
7. What is the function of the motor speech programmer?
The motor speech programmer is a neural network in the brain that sequences the motor movements needed to produce speech accurately.
a. analyzes the linguistic, motor, sensory, and emotional information through its connections with the cognitive, language, emotional and motor planning areas of the brain.  It sequences the information into a neural code that represents the muscular contractions need to produce the sequence of the intended utterance
b. it is thought to reside near the perisylvian area of the left hemisphere
8. What are the etiologies of apraxia
a. Damage to the perisylvian area of the left hemisphere; the insula; basal ganglia
b. Specific causes in order of frequency
i. Stroke (most frequent);
ii. degenerative disease,
iii. trauma; (surgical trauma in the left frontal lobe: aneurysm repair; removal of a tumor; hemorrhage evacuation)
iv. tumors, seizures,

9. What are the speech characteristics of apraxia of speech?
a. Speech that is labored and halting
b. Articulatory groping
c. Difficulty at the beginning of an utterance or word
d. Inconistent speech errors
10. What are the most common articulatory errors that are most helpful in making a diagnosis of apraxia of speech? (pg 286-7)
a. Substitutions more than other types of errors
b. Placement the most frequent manner error
c. Substitute voiceless for voiced sounds
d. More difficulty with the later developing sounds (fricatives more than stops)
e. Consonant clusters more difficult than singletons
f. Initial position of words are most problematic
g. Phonemes that are the least frequently occurring are most problematic
h. More problems with nonsense rather than meaningful words
i. More problems with multisyllabic words than single syllables
j. The farther the distance between the points of articulatory contact the greater the difficulty (puh puh vs. puh kuh)
k. Voluntary production more difficult than automatic, reactive,
l. Errors are inconsistent
m. Lip and alveolar sounds are the easiest.
11. How is prosody affected?
a. Rate of connected speech is slow
b. Equal stress is often placed on all syllables
c. Difficulty initiating speech
d. normal variations of pitch and loudness may be reduced
12. How are  respiration, resonance and phonation affected
a. Subtle difficulty with respiration
b. Resonance is seldom a significant problem
c. Seldom are there isolated deficits of phonation
13. What are some conditions that must be considered before making a diagnosis of apraxia and how is apraxia different from these?
a. Muscle weakness: If due to muscle weakness occurs both with voluntary and automatic/spontaneous movements
b. Sensory loss: can contribute to imprecise articulation; but again sensory loss would occur for all movements
c. Comprehension deficit: movement difficulties should not be related to comprehension of the task
d. Incoordination:  If due to incoordination, movement should be for automatic and spontaneous movements
14. What are three situations in which clinicians have difficulty making a differential diagnosis between apraxia and aphasia?
a. Differentiating pure apraxia from coexisting apraxia and aphasia and from aphasia alone.
b. Literal paraphasias (incorrect placement of one or more phonemes into a word) and apraxic errors
c. Apraxia errors from nonfluent language errors of Broca

15. How do we differentiate between pure aphasia and aphasia?
a. Pure apraxia: no problem with auditory comprehension, reading, and writing.
b. Aphasia will affect all four areas: speech, auditory comprehension, reading and writing
16. How do we differentiate between apraxia and paraphasias
a. Apraxia: anterior brand damage and right hemiparesis: parphasia: posterior brain damage and do not usually have hemiparesis
b. Apraxia usually have accompanying Broca’s aphasia; Paraphasia: Wernicke or conduction aphasia
c. Apraxia: prosody (halting, groping speech) Paraphasia: fluent normal prosody
d. Apraxia: difficulty initiating phonation; paraphasia fluent
e. Apraxia: phoneme and syllable substitutions are close to the intended sounds; paraphasia does not
17. How do you differentiate apraxia from Broca’s aphasia?
a. These can co-occur but with Broca’s aphasia there will be language difficulties
18. What are key evaluation tasks for apraxia?
a. SMR’s they are more affected than AMRS
b. Conversational speech and reading (groping/halting speech)
c. Repeating words of increasing length (fan fancy fantastic)

19. What are the general principles for treating apraxia of speech?
a. Not all individuals with apraxia of speech are appropriate candidates
i. Too aphasic
ii. May need to use gestures and AAC devices
b. Patients need to understand the characteristics of apraxia and rationale for treatment: Why treatment takes so long (relearning motor planning sequences); why there is some much repetition (motor learning); why progress may be slow (working with a damaged system)
c. Repetitive drill is essential to relearn the motor sequence
d. Treatment need to be sequenced from easy to more difficult to maintain a high success rate (80%)
e. Patients should learn to monitor their own work
f. Treatment should concentrate on functional and useful words as soon as possible

20. Briefly describe each of the specific treatments for apraxia.
a. Eight step continuum by Rosenbeck:  moving from easy to more difficult beginning with repeating target phonemes with the clinician to independent productions; emphasis on selecting early developing sounds first and easy CV structures first; functional words first; Begin with clinician models and simultaneous production “Watch me” with the client providing visual and auditory stimulation to removing clinician stimuli to
producing the targets with role-playing
b. Darley, Aronson, and Brown: begin with initiating speech gestures using automatic speech, shaping phonations, using facilitating consonants such as /m/; Using automatic responses; Phonemic Drill using nasals as facilitators from sounds to short utterances using “m” in CVC structures.
c. MIT:  melodic intonation therapy; using intoning accessed through the undamaged right hemisphere to facilitate speech; gradually producing the target utterances with normal prosody.
d. Prompt -- Prompts for restructuring oral muscular Targets; This program uses a combination of proprioceptive, pressure, and kinesthetic cues that show the patients how to sequence their oral movements for speech; the cues are provided by touching the patient’s face and manually guiding the articulators to the appropriate positions needed to produce the target sounds. The cues provide the patients with sensory information, relative timing of syllables, manner of articulation and co-articulations; premise is the clinicians are serving as the motor programmer