Apraxia of Speech and Apraxia of Phonation

Abstract

As a general concept, apraxia of phonation is less established than apraxia of speech, and there are fewer reports as well. Here we present a patient of dysphonia who exhibited apraxia of speech and Broca aphasia due to cerebral infarction of the left MCA area; we examined the patient for apraxia of phonation. The patient whispered on a continuing basis for more than eight months. Meanwhile, voiced elements were in evidence when the patient laughed or coughed. Dysphonia was dissociated from improvement in articulation. Inspection by nasopharyngolaryngoscope revealed instances when vocal cord movements during utterances lacked consistency, or when there were unnatural glottal closures and non-adduction of the vocal cords. Deviation in the timing of breathing and vocal cord movements was also observed during intentional coughing and deep breathing other than for utterances. Non-consistency, and automatic and voluntary dissociation with vocal cord movements were clear; and these were viewed as a form of apraxia. These findings suggest that dysphonia in this patient is marked by impairment of control of the higher center of the vocal cords.