Neuropsychologia 82 (2016) 171178

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Neuropsychologia
journal homepage: www.elsevier.com/locate/neuropsychologia

The role of metrical information in apraxia of speech. Perceptual

and acoustic analyses of word stress
Ingrid Aichert n, Mona Spth, Wolfram Ziegler
EKN Clinical Neuropsychology Research Group, Institu of Phonetics and Speech Processing, Ludwig-Maximilians-Universitt Mnchen, Germany

art ic l e i nf o a b s t r a c t

Article history: Several factors are known to inuence speech accuracy in patients with apraxia of speech (AOS), e.g.,
Received 31 August 2015 syllable structure or word length. However, the impact of word stress has largely been neglected so far.
Received in revised form More generally, the role of prosodic information at the phonetic encoding stage of speech production
8 December 2015
often remains unconsidered in models of speech production. This study aimed to investigate the inu-
Accepted 10 January 2016
Available online 11 January 2016
ence of word stress on error production in AOS. Two-syllabic words with stress on the rst (trochees) vs.
the second syllable (iambs) were compared in 14 patients with AOS, three of them exhibiting pure AOS,
Keywords: and in a control group of six normal speakers. The patients produced signicantly more errors on iambic
Apraxia of speech than on trochaic words. A most prominent metrical effect was obtained for segmental errors. Acoustic
Word stress
analyses of word durations revealed a disproportionate advantage of the trochaic meter in the patients
Trochee
relative to the healthy controls. The results indicate that German apraxic speakers are sensitive to me-
Iamb
Prosody trical information. It is assumed that metrical patterns function as prosodic frames for articulation
planning, and that the regular metrical pattern in German, the trochaic form, has a facilitating effect on
word production in patients with AOS.
& 2016 Elsevier Ltd. All rights reserved.

1. Introduction
Adult speakers rely on acquired implicit knowledge about how
to move their articulators for the production of speech sounds.
This knowledge is considered to be embodied in phonetic plans
which provide the basis of uent, automated speech. Apraxia of
speech (AOS), an acquired neurogenic motor speech disorder, is
conventionally dened as resulting from a deconstruction of such
information (e.g., Code 1998; for a review see Ziegler et al., 2012).
It may therefore provide a window into the internal make-up of
learned speech motor behavior.
This article deals with the architecture of speech motor plans as
inferred from speech errors of patients with AOS. More specically,
it addresses the question of how articulation planning for vowels
and consonants interacts with the rhythmical structure of speech.
This question is particularly controversial in psycholinguistic and
phonetic theories of speech production. The speech production
model developed by Levelt and coworkers (Levelt et al., 1999;
Cholin et al., 2004), for instance, takes a perspective in which the
segments of an utterance, i.e., its vowels and consonants, and the
metrical structure of the utterance are represented on different
tiers. The metrical frame of an intended word species the number
n
Corresponding author.
E-mail address: ingrid.aichert@ekn-muenchen.de (I. Aichert).
of syllables and, in cases of irregular stress, the main stress posi-
tion (Roelofs and Meyer, 1998). As soon as a words segmental and
metrical properties have been retrieved, syllabication rules are
applied to attach the segments, from left to right, to the metrical
template. The output of this association process, a syllabied
phonological word, constitutes the input to the phonetic encoding
stage of word production. The phonetic encoding component of
Levelt et al.'s (1999) speech production model dispenses with any
prosodic mechanisms. In this theory, the frequent phonological
syllables of syllabied words activate corresponding phonetic
syllables stored in a mental syllabary. The syllabary is considered
as a repository of holistic, overlearned motor plans containing the
gestural specications for the lower-level speech motor system
(Cholin et al., 2006; Cholin, 2008). Metrical structure plays no role
at this stage. As a consequence, if the phonetic encoder embodies
overlearned, automated aspects of speech motor behavior, the
motor patterns implementing, for instance, a trochaic vs. a iambic
rhythm, are in Levelt's theory not a part of this skill. Hence,
there is also no interaction between segmental and prosodic in-
formation within the phonetic encoding component of this model.
In contrast, phonetic studies provide abounding evidence for an
interplay of segmental with metrical information. Generally, the
realization of sounds is considered to be strongly inuenced by the
prosodic framework of an utterance. To mention only a few ex-
amples: In several studies stress-related strengthening effects,
i.e., more extensive and prolonged articulations in stressed vs.

http://dx.doi.org/10.1016/j.neuropsychologia.2016.01.009
0028-3932/& 2016 Elsevier Ltd. All rights reserved.
172 I. Aichert et al. / Neuropsychologia 82 (2016) 171178
unstressed syllables, were described (e.g., De Jong, 1995). Another
prosodic effect related to the strengthening concept is domain-
nal lengthening: A study by Wightman et al. (1992), for instance,
reported a more extreme lengthening at the end of higher pro-
sodic domains (e.g., intonational phrases) as compared to lower
prosodic domains (e.g., syllables). Similar effects have also been
described domain-initially (e.g., Fujimura, 1990). Several electro-
palatographic studies have for instance reported that consonants
are produced with greater articulatory magnitude in domain-in-
itial as compared to domain-medial positions at different levels
(e.g., Fougeron and Keating, 1997; Fougeron, 2001). These in-
vestigations are predominantly concerned with surface properties
of speech sounds and speech movements and refrain from draw-
ing inferences about the underlying phonetic encoding mechan-
isms. However, it can plausibly be assumed that at least some of
these surface phenomena are mediated by highly automated in-
terlinks between segmental and metrical properties at the pho-
netic encoding level and that they reect learned aspects of the
motor organization of speech. This assumption receives support by
more recent investigations. In a tongue twister experiment with
unimpaired speakers (Croot et al., 2010) it was shown that sen-
tence-level prominence, i.e. accent, protects against errors. Croot
and colleagues inferred from their results that segmental content
and prosodic structure of an utterance are integrated during the
phonetic encoding stage. In reading experiments, Sulpizio et al.
(2015) reported an inuence of word stress on reading latency and
pronunciation accuracy and concluded that stress assignment af-
fects the reading process during articulatory planning.
As regards the characteristics of the speech impairment in
patients with AOS, there is general agreement that segmental as-
pects of speech motor programming are affected in these in-
dividuals. The cardinal symptoms of the disorder, i.e., phonemic
errors and phonetic distortions, are considered segmental in nat-
ure because they affect the vowels and consonants of spoken
utterances (for an overview see McNeil et al., 2009). Moreover, a
wide range of factors related to the segmental structure of words
are known to inuence the error pattern of patients with AOS,
including, for instance, sound class or syllable complexity (e.g.,
Canter et al., 1985; Odell et al., 1990; Romani and Galluzzi, 2005;
Aichert and Ziegler, 2004a; Laganaro, 2008; Staiger and Ziegler,
2008; Galluzzi et al., 2015). In contrast, inuences of prosodic
properties (e.g., word stress) on accuracy in apraxic speakers have
been neglected so far, even though dysuency and prosodic im-
pairment are regularly mentioned among its clinical signs. Kent
and Rosenbek (1982, 1983) emphasized that syllable segregation
and a lengthening of steady-state segments and transitions (ar-
ticulatory prolongation) constitute characteristic symptoms of AOS
(for a similar pattern in cases of Primary Progressive Aphasia with
AOS see Ballard et al., 2014). Furthermore, a attening of the in-
tensity contours across syllable chains and of stress contrasts was
described (Kent and Rosenbek, 1982, 1983; Itoh and Sasanuma,
1984; Marquardt et al., 1995). In the Treatment guidelines for
acquired apraxia speech of the Academy of Neurologic Commu-
nication Disorders and Sciences (Wambaugh et al., 2006a) two out
of ve primary clinical characteristics are related to the supra-
segmental characteristics of the disorder (p. xvii). However, the
nature of the prosodic symptoms is controversial: some authors
assume that they result from a genuinely prosodic impairment
(e.g., Kent and Rosenbek, 1982, 1983; Boutsen and Christman,
2002), but others suggest that they reect a compensation of a
foremost segmental decit (e.g., Lebrun, 1990; Marquardt et al.,
1995).
Remarkably, the interplay between articulation and prosody
has been an issue in AOS therapy more than in basic research. A
number of rhythm-based treatment methods have been proposed
and considered successful in AOS therapy (for an overview see
Wambaugh et al. (2006b) and Ballard et al. (2015)). Some of these
techniques rely on internal rhythmical cues, such as nger tapping
(Wambaugh and Martinez, 2000), while others use external cues,
e.g. tactile (Rubow et al., 1982) or acoustic (Shane and Darley,
1978; Dworkin et al., 1988; Wambaugh and Martinez, 2000;
Brendel and Ziegler, 2008). Furthermore, rhythmic speech and
singing are basic elements of Melodic Intonation Therapy applied in
the treatment of severely impaired non-uent aphasics (e.g.,
Helm-Estabrooks et al., 1989; Sparks and Deck, 1994). Stahl et al.
(2011) compared the contribution of singing vs. rhythm in patients
with non-uent aphasia, most of whom were diagnosed with AOS,
and suggested that rhythm rather than melody was crucial in the
recovery of speech in these patients.
In sum, the results from treatment studies demonstrate that
the symptoms of AOS can be modulated positively by interven-
tions focused on the rhythmical aspects of speaking. Notably, the
effects of these approaches are apparently not conned to the
suprasegmental symptoms of apraxic speech (e.g. uency), but
they also encroach on articulatory accuracy at a segmental level.
What is still lacking, however, is an experimental approach to-
wards understanding how prosodic structure impacts speech
motor planning in patients with AOS.
Based on the premise that AOS provides a window into the
internal make-up of learned speech motor behavior, we here seek
evidence for an interaction of segmental and prosodic information
in speech planning by analyzing the factors inuencing the oc-
currence of speech errors in apraxic speakers. In a recent in-
vestigation including 33 patients with AOS we applied a nonlinear
regression model to predict apraxic speech errors on words and
nonwords as a function of gestural decomposition, syllable struc-
ture, syllable number, and metrical rhythm (Ziegler and Aichert,
2015). In this study we had discovered, among several other
things, that two-syllabic trochaic words, which constitute the
regular metrical pattern in German (Domahs et al., 2008; Wiese
2000; e.g., puma, engl. puma), were produced with fewer errors
than iambic words (e.g., men, engl. menu). However, since the
materials used in this experiment were not devised to examine
metrical inuences on speech in a very specic way, this nding
was obtained as a side effect which deserves closer investigation.
The present study was therefore designed to directly explore
the inuence of word stress in a new sample of apraxic speakers
by using highly specic and tightly controlled speech materials.
2. Method
2.1. Participants
Twenty-one patients with a diagnosis of apraxia of speech
(AOS) according to clinical records were recruited from twelve
clinical centers in Germany. Before inclusion they were screened
for participation by a thorough assessment of their spontaneous
speech and a word repetition test administered by the rst author.
Inclusion criteria were (1) a conrmed diagnosis of AOS, (2) no or
only very mild dysarthria, (3) no or only minor aphasic impair-
ment in word repetition, (4) intact auditory discrimination, and
(5) ability to participate in an auditory repetition test involving
two-syllabic words. Conrmation of the clinical diagnosis of AOS
was grounded on the following criteria (e.g., Ziegler, 2008):
(i) inconsistent occurrence of phonetic distortions and presence of
perceived phonemic errors, (ii) suprasegmental disturbances such
as intrasyllabic pauses, syllable segregation, or lengthening of
speech sounds and sound transitions, and (iii) visible/audible
groping, self-corrections, and effortful speaking.
From the initial patient sample of 21, seven participants failed
to match the inclusion criteria. Four patients suffered from a
 I. Aichert et al. / Neuropsychologia 82 (2016) 171178
Table 1
Demographic and clinical characteristics of the patient sample (n14).
Age in years: median (range) 64 (2687)
Months post onset: median (range) 8 (1144)
Etiology Ischemic (11), hemorrhagic (2),
traumatic (1)
Severity of aphasiaa No (3), mild (5), moderate (5), se-
vere (1)
Severity of AOSb 4 Mild, 9 moderate, 1 severe
Auditory word discrimination (LeMoc, 14 Unimpaired
test 2)
Auditory word-picture matching (LeMoc, 12 Unimpaired, 2 at threshold
test 23)
Verbal namingd (LeMoc, test 30) 6 Unimpaired, 2 at threshold,
6 moderate-severe
a
Aachener Aphasie Test; Huber et al. (1983).
b
Based on the percentage of segmentally correct items in the experimental
materials (mild: 470%/moderate: 3070%/severe: o 30% correct responses).
c
LeMo; De Bleser et al. (2004).
d
Responses with errors on only one phoneme (e.g.
) were scored as
correct.
notable dysarthric or aphasic impairment, and in three patients
speech apraxia was too mild given the low demands of the single
word repetition task administered here.
Therefore, 14 patients were nally included. All participants were
right-handed native speakers of German, most of them suffered from
an ischemic infarct. There was no clinically apparent difference be-
tween the 11 patients who had ischemic infarcts and the three pa-
tients with other aetiologies (for an overview of demographic and
clinical characteristics of the patient sample see Table 1).
According to the Aachener Aphasie Test (AAT; Huber et al.,
1983), three patients had no aphasia, hence were classied as pure
AOS. Only one patient was diagnosed with a severe aphasia. Most
patients had undisturbed auditory single-word processing abilities
as revealed by subtests 2 (auditory word discrimination) and 23
(auditory word-picture matching) from the LeMo battery (Lexikon
modellorientiert, De Bleser et al., 2004). Hence, auditory impair-
ment could be ruled out as a factor inuencing repetition accuracy.
An oral picture naming test (LeMo, test 30) revealed intact
word retrieval in six patients. Two patients were mildly disturbed,
and six patients displayed moderate to severe word-nding dif-
culties (Table 1). Regarding the error types in the naming task, the
patients with naming decits produced mainly null reactions
(50%) or semantic errors (35%). Of note, these two error types were
not observed in the experimental word repetition task.
Based on the results of these neurolinguistic data, a core as-
sumption of this study is that the patients' performance on the
experimental task used here, i.e., word repetition, was primarily
affected by their apraxic impairment, with a negligible aphasic or
dysarthric contribution. Furthermore, there was no relationship
between the severity of AOS and aphasia severity. More speci-
cally, the patient with the most severe AOS was only mildly
aphasic, and the patients with moderate AOS ranged across all
degrees of aphasia severity, from no aphasia to severe aphasia.
Severity of AOS was ranked on the basis of rates of overall seg-
mental errors made in the present repetition experiment. In four
cases the apraxic impairment was classied as mild ( o30% er-
rors), in nine cases as moderate (3070% errors), and in two cases
as severe (4 70% errors).
Six neurologically healthy control speakers (four female, two
male; age, mean: 51, range: 3673) were also examined.
173
Table 2
Organization of the word list, with an example for each word type.
Trochees (N 24) Lambs (N 24)
CV (N 16) Puma, engl. puma Kopie, engl. copy
CVC (N 16) Muskel, engl. muscle Kostm, engl. costume
CCVC/CVCC (N 16) Plastik, engl. plastic Kompost, engl. compost
2.2. Materials and procedure
The materials consisted of 48 two-syllabic nouns with stress on
the rst (trochees) or second syllable (iambs), respectively. The
word list was grouped into six sublists of 8 words each, including
words with simple CV and CVC structures and with complex syl-
lables in the stressed word position. All words were mono-
morphemic nouns of low lexical frequency (o10 spoken/written
per Million; CELEX database, Baayen et al., 1995). Trochees and
iambs were matched for phoneme density (mean phoneme
number per word in trochees: 5.25; in iambs: 5.17). The organi-
zation of the materials and examples are shown in Table 2.
Test words were also controlled for syllable frequency. Syllable
frequency counts were taken from a German syllable frequency
database (Aichert et al., 2005) based on the CELEX-corpus (Baayen
et al., 1995). T-tests failed to reveal signicant differences in syl-
lable frequency between the stressed syllables of the trochees and
the iambs (p4 .05) and the unstressed syllables of the two item
groups (p 4.05). A position-wise analysis revealed that fre-
quencies of the unstressed syllables in both positions were sig-
nicantly higher compared to the stressed syllables in the corre-
sponding position of the respective metrical cognates (position 1:
t2.72; po .01; position 2: t 4,63; p o.001).
The study was conducted in a single 60-min session during
which patients were administered the word list as well as the
subtests from the Lemo battery (De Bleser et al., 2004, see above).
The list was administered twice in two separate runs of an audi-
tory repetition task, resulting in a total of 96 items per patient and
1344 items overall. Items were presented in a pseudo-randomized
order.
2.3. Data analysis
Patients' responses were recorded on video- and audiotape
(video camera: Panasonic NV-GS180, external microphone: be-
yerdynamic TG-X-58). For auditory evaluation, each word was
transcribed phonetically by the rst author. Analyses were con-
ducted using both the auditory and the visual (mouth movement)
information. Symptoms which were not captured by the core IPA-
symbols (e.g., phonetic distortions or prosodic deviations such as
phoneme lengthening, intra- and intersyllabic pauses) were
marked with diacritics. Additionally, acoustic measures of word
duration were obtained using wideband spectograms of the re-
corded wav-les (Praat, 5.1.05; Boersma and Weenink, 2009).
2.3.1. Response accuracy
The patients' responses were rst analyzed with respect to
correct/incorrect productions. Whole words were considered as
error units, i.e., multiple errors on a word were counted as a single
word error. In case of multiple attempts, the rst response was
transcribed. Errors were classied as segmental and prosodic, re-
spectively. Segmental errors included phonetic distortions and
perceived phonemic errors (i.e., substitutions, additions or omis-
sions). Prosodic errors comprised phoneme lengthenings, schwa-
insertions and intersyllabic or intersegmental pauses. Reactions
that missed any phonological relationship to the target word (i.e.,
fragmentary responses) were marked as unclassied and were
174 I. Aichert et al. / Neuropsychologia 82 (2016) 171178
excluded from the statistical analysis. Furthermore, we also
documented the occurrence of visible or audible groping behavior
for each response.
In a second step, segmental errors were analyzed on a syllable-
by-syllable basis, i.e., errors on the rst and second syllable of each
word were counted separately.
2.3.2. Word duration
Word durations were measured by determining the onset of
the initial and the offset of the nal phoneme in the acoustic
signal. Whereas phonetically distorted reactions were included in
this analysis, items whose phonemic content was altered (i.e., by
single or multiple phonemic errors or by fragmentary responses)
were not considered.
Word duration measurements were also performed for the six
control speakers.
2.3.3. Statistics
All statistics were performed using R (R Core Team, 2015).
Generalized Linear Mixed Models were calculated using lme4
(Bates et al., 2015).
2.4. Reliability
2.4.1. Reliability of diagnosis
To validate the diagnosis of AOS, a second experienced speech
therapist who had no pre-information about the patients and who
was not aware of the research question was presented stretches of
spontaneous speech and extracts from a word repetition task of all
14 patients. Additionally, four patients with aphasic-phonological
symptoms were included in the classication rating. In a rst step,
the second rater was asked to classify each patient as either speech
apraxic or aphasic-phonological. In a second step she was asked to
evaluate how certain she was in her classication (certain, slightly
uncertain, very uncertain). Among the 14 patients included in this
study, the independent rater was in accordance with the original
diagnosis of AOS in 13 cases (certain: 10, slightly uncertain: 3). In
one patient who had pure AOS with only mild symptoms the rater
went for a classication as aphasic-phonological, qualifying her
decision as very uncertain. In all four patients with aphasic-
phonological disorder her classication was in accordance with
the prior diagnosis (certain: 2, slightly uncertain: 2).
2.4.2. Reliability of accuracy scores
In order to determine the reliability of the accuracy scores, the
rst 22 words of both runs (N 44 words) from four randomly
selected patients were analyzed by the same speech therapist who
also did the classication rating. There was substantial agreement
(Kappa statistics, Landis and Koch, 1977) between the two tran-
scribers for the segmental ( .785, po .001) and the supraseg-
mental whole-word errors ( .646, po .001). Furthermore, there
was almost perfect agreement for the evaluation of the groping
behavior ( .950, p o.001). Regarding the syllable-wise analysis
of the segmental errors we also found a signicant agreement
between the ratings for the rst syllable ( .768, p o.001/sub-
stantial agreement) and the second syllable ( .864, po .001/al-
most perfect agreement).
Regarding acoustic measurements, 28 words which were sui-
table for word duration analysis (i.e., phonemically correct pro-
ductions) from the four patients were re-analyzed (N 112 items).
A high correlation between the values measured by the two ex-
aminers was found (Pearson Correlation, r .998, po .001).
3. Results
3.1. Response accuracy: word-based errors
Since the healthy controls made no errors in the repetition task
they were not included in the error analyses. In the patient group,
25 out of 1344 responses (9 trochees, 16 iambs; 1,9%) were ex-
cluded as unclassied. The unclassied reactions were exclusively
due to fragmentary responses following articulatory groping.
There were no null reactions and no semantic errors in the re-
petition task.
Fig. 1 depicts mean error rates by stress type (trochee, iamb)
and syllable structure (CV, CVC, and complex). Word-based seg-
mental and prosodic errors and groping behaviors are plotted in
the left, middle, and right panels, respectively. Overall, the amount
of segmental errors signicantly outnumbered the amount of
prosodic errors and groping behaviors, respectively. This pattern
also held for each individual subject.
As a general tendency, higher error rates occurred on the
iambic as compared to the trochaic items. Average segmental error
rates across the three syllable types were .33 in the trochees vs. .55
in the iambs. Prosodic error rates were .10 vs. .14, groping rates .22
vs. .24. There was also an expected increase of error rates with
increasing syllable complexity.
Generalized linear mixed models (logit-link) were computed for
each error type separately, with the xed effects factors METER and
(syllable) STRUCTURE and the random effects factors PARTICIPANT, ITEM and
RUN. In order to account for the possibility that participants and
items might differ in their sensitivity to METER, random slopes were
also specied for by-PARTICIPANT and by-ITEM effects of METER. Good-
ness-of-t was estimated using the Hosmer and Lemeshow test (HL
test) for logistic models (Hosmer and Lemeshow, 1980).
The results are plotted in Table 3. For each model, signicant
deviation from the empirical data could be rejected by the HL test.
Goodness-of-t was poorest for the groping data. There were
signicant main effects of STRUCTURE across all error types, and a
signicant inuence of METER for the segmental and the prosodic
errors. There was also a signicant interaction of METER x STRUCTURE
in all three error variables. Plots of the random slopes of the by-
PARTICIPANT effects of METER revealed that the advantage of the tro-
chaic pattern regarding segmental and prosodic errors was
homogeneous across the apraxic participants, since coefcients
were all positive and varied within a very small range (segmental:
1.21.8; prosodic: 1.42.3).
Closer inspection of Fig. 1 reveals that the advantage of tro-
chees was much smaller for the words containing consonant
clusters than for the CV- and the CVC-words. A straightforward
explanation of this result is that in the trochees the clusters oc-
curred in the word onset (e.g., plastic), whereas in the complex
iambs the cluster was in the onset or the coda of the second syl-
lable (e.g.,so'pran, com'post), - an imbalance which was due to the
fact that iambs with complex word onsets are rare in German.
Hence, the results plotted in Fig. 1 suggest that the benet of the
trochaic pattern was partly outweighed by onset complexity,
especially in the case of the prosodic and the groping errors.
To compensate for this obvious inuence of onset position, a
further series of GLM logit models was conducted in which only
words with CV- and CVC-syllables were included. Table 4 plots the
results of these analyses, demonstrating that METER again had a
signicant effect on segmental and prosodic errors. In the absence
of the consonant cluster words, an inuence of syllable structure
was only seen on the prosodic errors, and the interaction of METER
with STRUCTURE disappeared. Again, the random slope coefcients of
the by-PARTICIPANT effects of METER were uniformly positive and
ranged within a small interval in the two analyses.
Although the inuence of the word stress pattern turned out to
 I. Aichert et al. / Neuropsychologia 82 (2016) 171178 175

Fig. 1. Mean error rates (word-based) as a function of stress and syllable structure. Left: segmental errors; middle: prosodic errors; right: groping behavior. The stressed
syllables had a CV-, CVC-, or a complex structure with a consonant cluster (CC).

Table 3
Generalized linear mixed logit models of the inuence of metrical pattern (trochaic vs. iambic) on segmental and prosodic word level errors and on the occurrence of
groping.

HL-test Segmental errors 2(8) 9.8; p .28 Prosodic errorsa 2(8) 10.5; p .23 Groping 2(8) 15.2; p .06

Wald z df sig Wald z df sig Wald z df sig

METER 4.39 1 *** 2.47 1 * 1.70 1 n.s.
STRUCTURE 4.12 2 *** 5.21 2 *** 3.31 2 ***
METER  STRUCTURE  2.18 2 *  2.42 2 *  2.00 2 *

The structure of the stressed syllable (CV, CVC, complex) was modeled as a further xed factor. Participants, items and runs (rst vs. second) were included as random effects
factors. HL-test: Hosmer & Lemeshow (p-values4 .05 indicate that the model should not be rejected). Signicance levels: *** p o .001; ** p o .01; * p o .05; ns not signicant.
a
Since 8 patients made no prosodic errors in one or several conditions, the model was calculated for only the six remaining participants.

be homogeneous across the apraxic participants in almost all
analyses, whole-word errors were also analyzed for each single
participant. In these analyses, words with complex clusters were
excluded and the CV- and CVC-conditions were collapsed. Pear-
sons chi-squared tests were performed, with an alpha-level of .05.
Regarding segmental errors, 9/14 patients were signicantly less
accurate on iambic than on trochaic words, among them were two
of the three patients with pure AOS. Three of them also produced
signicantly more prosodic errors on the iambic as compared to
the trochaic words. Additionally, one further patient (the third
patient with pure AOS) also showed a facilitating trochee-effect in
his groping behavior. Reverse effects were not observed in any of
the 14 participants on any of the three error variables.
3.2. Response accuracy: syllable-based errors
In order to investigate whether the metrical effects reported
above were ascribable to syllable position or syllable stress, syl-
lable-wise error counts were analyzed. Fig. 2 depicts mean error
rates as a function of syllable position (rst vs. second) and stress
(stressed vs. unstressed).
On the average there was an overall tendency towards more
errors on the rst relative to the second syllable (28% vs. 20%) and
also a slightly greater vulnerability of stressed vs. unstressed syl-
lables (26% vs. 23%). Interestingly, however, the stressed rst syl-
lable of the trochees was produced more accurately than the un-
stressed rst syllable of the iambs, demonstrating that the me-
trical effect outweighed the syllable-stress effect by far. Moreover,
the nal stressed syllables of the iambic words were more error-
prone than the initial stressed syllables of the trochees, indicating
that the overall benet of the nal vs. the initial syllable was re-
versed in the stressed condition, i.e., the metrical effect outplayed
the disadvantage of the initial position.
A generalized linear mixed logit model with two xed effects
factors (STRESS, POSITION) and the random effects factors PARTICIPANT and
ITEM explained the data signicantly (LH (8) 10.56, p .23). Both
2
the POSITION (Wald-z(1)  6.2, p o.001) and the STRESS effect (Wald-
z(1) 3.1, p o.01) became signicant, and there was also a sig-
nicant STRESS x POSITION interaction (Wald- z(1) 6.7, p o.001).
3.3. Word duration
In the control group, all word productions were phonemically
correct und could therefore be included in the acoustic analyses. In
the patient group, only 65% of all items (n 875) could be analyzed
for word duration. There were more trochaic (n 505) than iambic
words (n 370) remaining in the analysis, which reects the
higher vulnerability of iambic words. Yet, the distribution of ana-
lyzable items across the three syllable structure types was similar
in the trochaic and the iambic words, with at least 110 items per
syllable structure remaining in each word stress category.
Fig. 3 depicts average word duration as a function of metrical
pattern and syllable complexity for the healthy participants (left
panel) and the AOS patients (right panel). As can be seen in Fig. 3,
iambic words tended to have longer durations than trochaic words
(mean difference across groups and syllable structures: 99 ms).
Words with complex syllables were produced with the longest
durations, and this effect was more pronounced in the trochaic
than in the iambic words.
A linear mixed model was calculated with the xed effects
factors METER (trochees vs. iambs), STRUCTURE (CV, CVC) and GROUP
(controls vs. AOS patients) and the random effects factors PARTICI-
PANT, ITEM, and RUN. Due to the position asymmetry of consonant
clusters in trochees vs. iambs (see above), the analysis was con-
ned to the CV and CVC stimuli. Signicant main effects of METER (F
(1, 35.1) 22.5, p o.001) and of STRUCTURE (F(1, 35.1) 4.3, p o.05)
176 I. Aichert et al. / Neuropsychologia 82 (2016) 171178
Table 4
Generalized linear logit models as in Table 3 above, with the difference that syllables with consonant clusters were excluded, i.e., the factor STRUCTURE includes only two levels
(CV, CVC).
HL-test Segmental errors 2(8) 13.6; p .09 Prosodic errorsa 2(8) 8.0; p .43
Wald z df sig Wald z
METER 4.72 1 *** 2.85
STRUCTURE 1.85 1 n.s. 2.83
METER  STRUCTURE  .77 1 n.s.  1.84
Signicance levels: ***p o .001; ** p o .01; *p o .05; ns not signicant.
a
Since 8 patients made no prosodic errors in one or several conditions, the model was calculated for only the six remaining participants.
Fig. 2. Segmental errors per syllable (in %), broken down by syllable position (rst
vs. second) and syllable stress (stressed: lled squares; unstressed: open circles).
Labels indicate how the four syllable types combine in the two metrical patterns.
were obtained. There was also a signicant main effect of GROUP (F
(1, 14.9) 5.5, p o.05), i.e., patients with AOS had signicantly
longer word durations than the controls, with an average differ-
ence of 136 ms. Most importantly, a signicant GROUP x METER in-
teraction was found (F(1, 690.0) 13.0, po .001), indicating that
the disadvantage of the iambic pattern was stronger in the pa-
tients than in the healthy participants.
Taken together, these acoustic data provide additional and
objective evidence for a metrical inuence on specically the
prosodic aspects of apraxic speech. The fact that the metrical effect
was still there after exclusion of the more vulnerable items (i.e.,
items with phonemic errors) argues for the robustness of the
effect.
4. Discussion
This is the rst systematic investigation of how word stress
affects error production in apraxia of speech. A group of 14 pa-
tients with left hemisphere strokes whose single word production
was predominantly inuenced by their apraxic speech impairment
was examined by a word-repetition task involving disyllabic
words with a trochaic (i.e., stressedunstressed) and an iambic
(i.e., unstressedstressed) metrical pattern. The words were sys-
tematically varied for the structure of stressed syllables and were
paralleled for lexical frequency, syllable frequency, and phoneme
number. As a general result, trochees (which constitute the pre-
dominant metrical pattern in German) were less error prone than
iambs. The benet of the regular ( trochaic) pattern was parti-
cularly pronounced with regard to rates of segmental errors, but
was also found in prosodic error counts (prolonged sounds and
sound transitions, within-word pauses). Furthermore, an impact of
metrical patterning was also observed on word durations. Dura-
tions turned out to be longer for iambic than for trochaic words in
Groping 2(8) 24.8; p o.01
df sig Wald z df sig
1 ** 1.37 1 n.s.
1 ** 1.46 1 n.s.
1 n.s.  .88 1 n.s.
both the healthy control speakers and the apraxic patients, but the
effect was signicantly stronger in the patients. As regards groping
behavior, there was no signicant inuence of word stress at the
group level (though individual patients did show a metrical effect).
Instead, groping for articulations appeared to be more related to
word onset complexity.
Syllable-wise error counts revealed that the impact of a words
metrical pattern on segmental accuracy was not ascribable to
syllable-related factors like position, stress, or frequency. It is
widely accepted that apraxic speakers are susceptible to failure at
word onsets and less vulnerable at the end of a word (e.g., Aichert
and Ziegler, 2013a; Canter et al., 1985; Croot, 2002). However, in
this study the rst syllable of the trochees was produced more
accurately than both syllables of the iambs. Therefore, the metrical
effect emerged to be stronger than the position effect. To give an
example: the stressed syllable [ju:] in the trochee judo (engl. judo)
was produced with a considerably lower error rate (45%) than the
unstressed syllable [ju:] in the iamb ju'wel (engl. jewel, error rate:
64%), despite the fact that the two syllables have the same seg-
ments. Furthermore, we found that stressed syllables were not
per se more error-prone than unstressed syllables, as would have
been predicted by Odell et al. (1991). To the contrary, the rst,
unstressed syllables of the iambic words were even produced with
the highest error rates. This nding deserves particular mention
because the rst syllables of the iambic words had higher syllable
frequencies than the rst syllables of the trochaic words. Ob-
viously, the inuence of the regular metrical pattern even out-
played the syllable frequency effect that has been described in
several earlier studies (Aichert and Ziegler, 2004a; Laganaro, 2008;
Staiger and Ziegler, 2008).
Notably, however, the trochee effect did not swamp all seg-
mental inuences, especially not the consonant cluster effect
observed earlier (e.g., Aichert and Ziegler, 2004a). In the experi-
ment described here, the presence of consonant clusters in the
stressed syllables attenuated the trochaic advantage, presumably
because the clusters occurred in the word onsets of the trochees,
but word-medially or -nally in the iambs. Onset clusters were
particularly vulnerable to errors, and especially for the prosodic
and groping errors they nullied or even reversed the metrical
effect.
Overall, the results presented here show that segmental and
prosodic factors interact closely in apraxia of speech and should
therefore not be considered independent in their inuence on
speech motor planning. Hence, our study provides new evidence
for a nonlinear architecture of speech motor representations, in
which the articulatory primitives of speech motor planning, i.e.,
phonetic gestures for the articulation of vowels and consonants,
are dominated by the rhythmical patterning of words (cf. Ziegler,
2005, 2009; Ziegler and Aichert, 2015). This perspective is at var-
iance with theories suggesting that the phonetic encoding me-
chanism operates on linear strings of phonemes or syllables. In the
inuential model proposed by Levelt et al. (1999), for instance,
metrical properties of utterances are accessed independently from
the segmental content during word form (phonological) encoding
 I. Aichert et al. / Neuropsychologia 82 (2016) 171178
Fig. 3. Word duration as a function of metrical and syllabic structure. Left: healthy controls; right: AOS patients.
and play no role at the subsequent phonetic encoding stage. There
is also some neurolinguistic evidence supporting such a dualist
view of segmental vs. prosodic encoding, as for instance data from
an earlier study in which we reported on two aphasic patients
with a mutually dissociating pattern of segmental and prosodic
errors (Aichert and Ziegler, 2004b), or other reports of patients
whose impairment was purely prosodic since they mis-stressed
words with an irregular metrical pattern (Cappa et al., 1997; La-
ganaro et al., 2002). A weak interaction of segmental with prosodic
information was demonstrated in aphasic patients who showed a
tendency to omit unstressed syllables and to make more seg-
mental errors on unstressed as compared to stressed syllables
(Nickels and Howard, 1999).
In plain contrast, the AOS patients of the present study ex-
hibited no bias for unstressed syllables to be universally more
vulnerable, but rather showed that segmental accuracy is a func-
tion of the overall metrical organization of a word. Furthermore,
there was no case where a word was mis-stressed, i.e., an iambic
target word realized with a trochaic stress pattern or vice versa.
This contrasts with reports of inappropriate word stress patterns
in related aetiologies, such as childhood apraxia of speech (e.g.,
Shriberg et al., 2003) and foreign accent syndrome (e.g., Miller
et al., 2006). Our result may be explained by assuming that the
assignment of stress is already completed when the phonological
word form is fed into the phonetic encoding process.
The facilitating effect of the trochaic (i.e., the predominant,
regular, unmarked) stress pattern in our patients with AOS sup-
ports studies of normal speakers which also pointed at a close link
between segmental and prosodic aspects and an advantage of the
trochee in speech motor planning (e.g., Croot et al., 2010; Sulpizio
et al., 2015). We assume that, at least for German, the strong-weak
stress pattern constitutes a particularly stable architecture, in
which the lower-level gestural and syllabic motor routines for
words are organized more coherently than in words with a weak
strong pattern.
From a clinical perspective, the results of this study suggest
that the facilitating effect of the regular word stress might also be
helpful in the treatment of apraxic speakers. Choosing words with
a regular stress pattern may enhance speech motor learning in
patients with AOS. In a recent learning experiment in which we
investigated the effectiveness of syllable-based learning in AOS
(Aichert and Ziegler, 2013b) we found that the learning of single
syllables led to improvements on (untrained) two-syllabic trochaic
words. Obviously, the transfer from single syllables to trochees
required only little extra motor planning for these patients. In a
treatment report of a German patient with chronic, pure AOS
(Aichert and Ziegler, 2010) we used metrically structured phrases
177
composed of trochaic words (e.g., eine laute Pauke, engl. a loud
timbal) and poems with an underlying regular metric (e.g., Goe-
the's "The Sorcerer's Apprentice"). Anecdotally, after the rst ex-
ercises with these materials the patient was struck by experien-
cing an immediate increase in uency. After 20 treatment sessions
we observed a clearly increased speaking rate.
Taken together, these data show that the regular metrical
pattern in German, the trochaic form, facilitates articulatory ac-
curacy and articulatory uency in patients with AOS. We assume
that trochees are particularly stable phonetic patterns in German.
Furthermore, the results suggest that segmental and prosodic as-
pects of speech motor planning are intertwined, which ts well
with earlier suggestions of a hierarchically nested organization of
phonetic plans (Ziegler and Aichert, 2015). Finally, the results
presented here may also contribute to discussions about the units
to be chosen as treatment targets in AOS therapy.
Acknowledgments
The rst author of this study was supported by a grant from the
German Research Council (Deutsche Forschungsgemeinschaft
[DFG], Grant Zi 469/141). We are grateful to the patients and to
the healthy control speakers for their participation. Furthermore,
we thank Bernadette Vgele for contributing to the reliability
analyses.
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