1. Communication after a Stroke
Aphasia and Apraxia of Speech

2. Topics to cover Aphasia Apraxia Definition Incidence/Prevalence
Characteristics
Assessment Measures
Treatment
Support
Definition
Causes
Characteristics
Assessment Measures
Treatment
Support

3. What is Aphasia?
Aphasia is an acquired neurogenic language disorder resulting from an injury to the brain, most typically the left hemisphere, that affects all language modalities (ASHA, 2015).
Stroke is the most common cause of aphasia and apraxia; however, it can also be diagnosed after a lesions or trauma to the brain.

4. Incidence and Prevalence- Aphasia
Approx 35-40% of patients who suffer a stroke are diagnosed with some form of aphasia. (Dickey et al., 2010; Pedersen, Jorgensen, Raaschou, & Olsen, 1995).
It is estimated that there are 80,000 new cases of aphasia per year in the United States (National Stroke Association, 2008).
The National Institute of Neurological Disorders and Stroke (NINDS) estimates that approximately 1 million people, or 1 in 250 in the United States today, suffer from aphasia (NINDS, n.d.).

5. Aphasia
A language disorder resulting in the difficulty to communicate and understand language.
The four modalities of language
Listening comprehension
Reading comprehension
Verbal expression
Writing expression
Affects on language, not on intellect

6. Language centers
Arcuate fasiculus (language loop)

7. Types of Aphasia Wernicke’s Broca’s Decreased auditory comprehension
Fluent Aphasia
Most associated with Apraxia
Decreased verbal expression
Non-Fluent Aphasia
Slow, halting, effortful speech

8. Wernike – Geshwind Model (The Brain from Top to Bottom)
A word is heard
processed in your auditory cortex
Wernike’s area (links with a word in your memory)
word is now associated with a meaning
A word is read
processed by your visual cortex
sent to Wernike’s and again is linked with memory
A word is read aloud
originates from the “dictionary” in Wernike’s
gets looped to Broca’s area in order to be pronounced
planning articulators
motor cortex for speech movement
A word is spoken

9. Characteristics of Aphasia
Listening Comprehension
Decreased understanding
Unreliable Y/N
Reading Comprehension
Alexia: loss in ability to recognize letters, words, etc.
Writing Expression
Agraphia: loss in the ability to communicate by writing
Verbal Expression
Word finding: Anomia
Paraphasias
perseverative, phonemic, verbal, neologistic etc.
Phonemic: “speep” for “speech”
Verbal: “garbage” for “garage”

10. Assessment Measures - Aphasia
Screening versus Comprehensive assessment
Standardized Testing
BDAE (Boston Diagnostic Aphasia Examination)
WAB (Western Aphasia Battery
Non-Standardized Testing
Observational methods

11. Treatment (ASHA, 2015)

12. Aphasia support
For information on organizations, research and clinical trials
St. Luke’s Stroke club
Academy of Neurologic Communication Science and Disorders
Aphasia Hope
National Aphasia Association
Stroke Association
Emotional aspects of a stroke, and loss of communication

13. What is Apraxia of Speech? - Adults
Apraxia of speech is a motor disorder that is a result of vascular lesion in the left subcortical region.
The inability for volitional movement of the speech articulators.
It is not muscle weakness.

14. Apraxia
Disconnect between the words in the brain, and how to form the movements of those speech sounds.
Limited research on prevalence and incidence.
Often co-morbidities such as dysarthria (muscle weakness) or aphasia (language disorder).

15. Characteristics of Apraxia
Groping – most often with initiation
Slowed pace
Limited or no usable speech
Difficulty performing “non-speech” tasks upon request
Awareness and frustration
Inconsistent errors

16. Causes of Apraxia
Acquired versus Developmental
Adult is acquired

17. Assessment Measures - Apraxia
Diagnosed by a speech-language pathologist after informal and formal testing procedures
Speech sample in conversation
Oral mechanical examination
Motor speech evaluation
Apraxia vs Dysarthria

18. Treatment for Apraxia Three steps
Planning
Sequencing
Muscle coordination (slow rate, pacing)
Retraining the brain. Make new connections. Repetitive practice.
Gestures
Guess my communicative intent
Writing
AAC
Alphabet boards
Picture boards
Speech isn’t just speech

19. Treatment of Apraxia Melodic Intonation Therapy (MIT)
PROMPT – involving tactile cues for articulators
Minimal pairs imitation
Key word approach
Phonetic placement
Practice, practice, practice

20. Apraxia support
For information on organizations, research and clinical trials
St. Luke’s Stroke club
National Institute of Neurological Disorders and Stroke
National Institute of Deafness and other Communication Disorders

21. References
Aphasia and the Brain (2015). Wernike and Broca History. Image retrieved January 11, 2015 from
The Brain from Top to Bottom (2015). Broca’s Area, Wernike’s Area, and other Language-Processing Areas in the Brain. Retrieved January 11, 2015 from
National Institute on Deafness and Other Communication Disorders (2015). Apraxia of Speech. Retrieved January 11, 2015 from
National Institute of Neurological Disorders and Stroke (2015). Apraxia Information Page. Retrieved January 11, 2015 from
The Stroke Comeback Center, VA. Williamson, Darlene M.S., CCC-SLP. Adult Acquired Apraxia of Speech: Principles, Practice and Technology. Retrieved January 11, 2015 from

22. Questions???