Clinical and anatomical correlates of apraxia of speech.

In a previous study (Dronkers, 1996), stroke patients identified as having apraxia of speech (AOS), an articulatory disorder, were found to have damage to the left superior precentral gyrus of the insula (SPGI). The present study sought (1) to characterize the performance of patients with AOS on a classic motor speech evaluation, and (2) to examine whether severity of AOS was influenced by the extent of the lesion. Videotaped speech evaluations of stroke patients with and without AOS were reviewed by two speech-language pathologists and independently scored. Results indicated that patients with AOS made the most errors on tasks requiring the coordination of complex, but not simple, articulatory movements. Patients scored lowest on the repetition of multisyllabic words and sentences that required immediate shifting between place and manner of articulation and rapid coordination of the lips, tongue, velum, and larynx. Last, all patients with AOS had lesions in the SPGI, whereas patients without apraxia of speech did not. Additional involvement of neighboring brain areas was associated with more severe forms of both AOS as well as language deficits, such as aphasia.