126 Chapter 6
speak spontaneously. You also test her mathematical expression and reception because math,
too, is a language. Based on the results of the aphasia testing, you find that the stroke has had
little effect on the fabric of Corrine’s language.
Testing for dysarthria includes determining Corrine’s respiratory support for speech produc-
tion. You check to see whether she can create the necessary breath support for speech and sustain
it in a controlled, efficient manner. You also assess voice quality, onset, and control, as well as pitch
range and overall loudness. You decide that when the patient can program speech motorically, it
is about 90% intelligible due to the paresis of her articulatory muscles, particularly those of her
tongue. Fortunately, it appears that the stroke did not interfere with her nasal valving mechanism,
and she is not hypernasal. Her speech prosody is only minimally affected.
During the testing, Corrine strug gles to produce sounds, syllables, words, and phrases pur-
posefully. Curiously, she can say some words automatically. Although this is the first patient
you have evaluated with a neurogenic communication disorder, you suspect that this automatic-
purposeful dichotomy in speaking is automatic speech. The best example of such speech occurred
when Corrine repeatedly pointed to a picture of her daughter on the table and tried to say her
name: Maggie. It sounded like “aggie,” “staggie,” “uh- aggie,” and “raggie.” Then, when Corrine’s
attention was directed elsewhere and she gave little thought to the word, she easily and correctly
said, “I can’t seem to say ‘Maggie’ today,” although with minor distortions caused by the dysar-
thria. You have learned that this automatic speech be hav ior is usually considered part of apraxia
of speech. You begin this aspect of the evaluation with a clinical hypothesis that Corrine’s major
neurogenic communication disorder is apraxia of speech.
Testing for apraxia of speech primarily involves repeating utterances of increasing length.
Apparently, repeating requires the patient to program her articulators consciously, making the
be hav ior more voluntary. First, she must repeat vowels in isolation; Corrine repeats several of
them, although she strug gles and has difficulty placing her articulators in the proper positions.
In the “Comments” section of the test, you note that she also has prob lems programming air-
f low, creating voicing, and producing the articulatory positioning for vowels. You similarly test
continuants, plosives, affricates, and diphthongs, with Corrine scoring poorly on each subtest.
Testing her ability to repeat syllables of increasing length also shows severe impairment in motor
programming, sequencing, and executing speech movements during repetitions. You continue to
test multiple word constructions, multiple repetitions of multisyllable words, progressively lon-
ger words, and phrases. The final aspect of this test battery for apraxia of speech focuses on the
patient’s ability to count, say the alphabet, and name the days of the week and months of the year.
Corrine continues to strug gle with these tasks. On a positive note, you observe that she is usually
aware of her errors; unfortunately, she is rarely self- corrective. According to her test score, Corrine
suffers from severe apraxia of speech and oral apraxia. Your clinical hypothesis is confirmed: This
patient’s primary neurogenic communication disorder is apraxia of speech.