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Anatomy of oral apraxia and speech apraxia: A VLSM study in a cohort of left-hemisphere brain-damaged patients

Enrico Ripamonti1*, Giuseppina Zonca2 and Claudio Luzzatti3, 4
  • 1 Fondazione Don Carlo Gnocchi Onlus (IRCCS), Italy
  • 2 Istituti Clinici Scientifici Salvatore Maugeri, IRCCS di Montescano, Italy
  • 3 Università degli studi di Milano Bicocca, Department of Psychology, Italy
  • 4 Milan Center for Neuroscience (NeuroMi), Italy

Oral apraxia (OA) reflects impairment in performing actions and gestures involving bucco-facial muscles, such as blowing a kiss or sticking out the tongue. OA would be more frequent in non-fluent rather than in fluent aphasia (Square-Storer, Qualizza, & Roy, 1989), and this would lead to hypothesize a relatively anterior localization of the underlying center for programming complex movements of the oral district. Consistently with this prediction, Kolb and Milner (1981) described correlations of OA with left frontal lesions, and, according to Alexander et al. (1992) its anatomical substrate would only include Broca’s area and the underlying white matter. However, Tognola and Vignolo (1980) found association with the left superior temporal gyrus and left anterior insula, and with the left frontal and central opercula. Thus, the specific anatomical substrate of OA is still uncertain. In the present study we tackled this issue using an anatomo-clinical correlative procedure (subtractions and voxel-based lesion-symptom mapping, VLSM) in a sample of 48 left-hemisphere brain-damaged patients. The inclusion criteria for the study were: (i) right handedness; (ii) no prior history of psychiatric or neurologic disease; (iii) no paretic-type dysarthria. OA has been tested asking patients to imitate ten oral gestures (De Renzi, Pieczuro & Vignolo, 1966). Scores 0-2 are attributed to the execution of each gesture and patients with total score below 16 were diagnosed with OA (De Renzi et al., 1966). These scores were entered as dependent variable in a first VLSM analysis. A network of left perisylvian areas emerged as anatomical correlate of OA (see Figure), including the left insular cortex, the left frontal and central opercula, the left inferior frontal gyrus (pars opercularis). These results are relatively consistent with those previously reported by Tognola and Vignolo (1980). A second objective was that of differentiating the anatomical basis of OA from that of apraxia of speech (AoS). In fact, while OA and AoS can be differentiated functionally, as only the latter involves impairment of articulatory programming, few studies have attempted to disentangle their anatomical basis. As to AoS, Hillis et al. (2004) suggested a specific role of the inferior frontal gyrus, while Dronkers and Ogar (2004) reported association with the left anterior insula. AoS was assessed using the AAT articulation and prosody ordinal scores [0-5] (Huber et al., 1983; Luzzatti et al., 1996). These scores were entered as dependent variable in a second VLSM analysis. Data from the present study indicate that the network of left hemisphere areas damaged in OA is partially damaged also in AoS, but, differently from OA, such impairment is associated with lesions of the left inferior frontal gyrus (pars triangularis) and of the left precentral gyrus (see Figure). These results point to the existence of relatively different anatomical specializations in the left hemisphere, with regards to motor programming of bucco-facial gestures and speech articulation.

Figure 1
Image

References

Alexander, M.P., Baker, E., Naeser, M.A., Kaplan, E., & Palumbo, C. (1992). Neuropsychological and neuroanatomical dimensions of ideomotor apraxia. Brain, 115, 87-107.
De Renzi, E., Pieczuro, A., & Vignolo, L.A. (1966). Oral apraxia and aphasia. Cortex, 2, 50-73.
Dronkers, N., & Ogar, J. (2004). Brain areas involved in speech production. Brain, 127, 1461–1462.
Hillis, A. E., Work, M., Barker, P. B., Jacobs, M. A., Breese, E. L., & Maurer, K. (2004). Re-examining the brain regions crucial for orchestrating speech articulation. Brain, 127, 1479-1487.
Huber, W., Poeck, K., Willmes, K. & Weniger, D. (1983). Aachener Aphasie Test. Göttingen: Hogrefe.
Kolb, B., & Milner, B. (1981). Performance of complex arm and facial movements after focal brain lesions. Neuropsychologia, 19, 491-503.
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Square-Storer, P., Qualizza, L., & Roy, E.A. (1989). Isolated and sequenced oral motor posture production under different input modalities by left-hemisphere damaged adults. Cortex, 25, 371–386.
Tognola, G., & Vignolo, L.A. (1980). Brain lesions associated with oral apraxia in stroke patients: a clinico-neuroradiological investigation with the CT scan. Neuropsychologia, 18, 257-272.

Keywords: voxel-based lesion-symptom mapping (VLSM), Oral apraxia, apraxia of speech, Aphasia, Neuroimaging

Conference: Academy of Aphasia 56th Annual Meeting, Montreal, Canada, 21 Oct - 23 Oct, 2018.

Presentation Type: poster presentation

Topic: not eligible for a student prize

Citation: Ripamonti E, Zonca G and Luzzatti C (2019). Anatomy of oral apraxia and speech apraxia: A VLSM study in a cohort of left-hemisphere brain-damaged patients. Conference Abstract: Academy of Aphasia 56th Annual Meeting. doi: 10.3389/conf.fnhum.2018.228.00064

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Received: 27 Apr 2018; Published Online: 22 Jan 2019.

* Correspondence: Dr. Enrico Ripamonti, Fondazione Don Carlo Gnocchi Onlus (IRCCS), Milan, Italy, enripamonti@dongnocchi.it