Motor Speech Disorders 125Although the /f/ sound is produced in the front of the mouth and was easily modeled by the
therapist, no amount of drilling could help Stephanie program it consistently, especially when it
occurred in the initial position of words. At work, for example, when a customer asked for direc-
tions, Stephanie was unable to say clearly, “Aisle four.” Because of the apraxia of speech, she said,
“Aisle tufor, no, I mean, suhor, uh uh, sooor.” Fi nally, in desperation, she held up four fin gers and
pointed to the aisle, suffering the customer’s perplexed expression.
In outpatient therapy, Stephanie found that if she concentrated on nonspeech oral movements
before making the /f/ phoneme, she could usually produce it. She concentrated on the oral move-
ments necessary to bite her lower lip and then produced the /f/ sound correctly. Stephanie’s clini-
cian supplied word lists with the /f/ phoneme in the initial position of words. Stephanie consciously
programmed her articulators to bite her lower lip and then shift that movement to the word with
the /f/ phoneme. She also learned to program this sound the same way when it occurred in the
medial and final positions of words.
For several years following her stroke, Stephanie still had occasional difficulty programming
the /f/ phoneme. Each time she started to strug gle with it, she remembered to concentrate on bit-
ing her lower lip and then gradually program the phoneme correctly. What was once a debilitating
speech disorder gradually became an occasional minor nuisance.
Case Study 6-5: Apraxia of Speech in a
52- Year- Old Newspaper Editor
Corrine is the first adult patient with a neurogenic disorder you will evaluate alone, and after
reading her chart, you seriously question your competence to do so. You are only a second- year
gradu ate student, and your name tag reads “student clinician.” Fortunately, your clinical super-
visor has reminded you that most student clinicians question their competence at some time,
and those who do not should. A feeling of inadequacy shows that you have the proper perspec-
tive and appreciate the magnitude of the undertaking. You will soon enter the patient’s hospital
room and begin the evaluation. Several weeks ago, the patient, Corrine, fell ill and silent at work.
According to the chart, she suffered a cerebrovascular accident and is partially para lyzed on the
right side.
You enter the hospital room and see a middle- aged woman watching tele vi sion. She is sitting
at a small table next to the hospital bed. You introduce yourself, explain your professional role,
and ask her to describe her communication disorder. Corrine does her best. Struggling to use
telegraphic, forced speech, she says several times, “I know what I want to say, but I cannot say it.”
You know that her statement suggests several levels of communication impairments. First,
Corrine may understand the images, sensations, and intuitions in her mind but may have no
words to express them— a description of expressive aphasia. Second, she may be describing not
the loss of words for expression, but the motor speech programming necessary to utter them.
She may have apraxia of speech (verbal apraxia). Fi nally, she may be describing the effects of
paralysis and the resulting inability to make her speech muscles valve the compressed air com-
ing from her lungs: dysarthria.
The first aspect of your evaluation involves testing for aphasia. You have been taught the
theory and administration of several aphasia batteries. However, at this clinical site, your
supervisor suggests that, rather than rely on one instrument, you should administer sections
of several aphasia tests. You do so and assess the patient’s ability to follow directional com-
mands, point to objects when named, and answer “yes” and “no” correctly. You see whether
Corrine can match printed and written words to pictures, read aloud, and follow written
instructions. Then you have her write sentences, name objects, and write to dictation. Next,
you assess her verbal ability to describe and name common objects, complete sentences, and