Apraxia of Speech

What is Apraxia of Speech?

Apraxia of speech (AOS) is a speech disorder that affects an individual's ability to articulate fluently. Damage to specific areas of the nervous system cause an interruption of messages sent from the brain to the muscles in and around the mouth (oral muscles).

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This interruption often causes an individual with apraxia to sound like they are stuttering.

The most frustrating part of this speech disorder is that the affected person knows exactly what they want to say, but they can't get their mouth to move in the way they want it to.

Common Characteristics:

Substitutions: Individuals with apraxia of speech often use an incorrect consonant or vowel sound when producing words.

For example, when trying to say the word, "cat," they may substitute a "T" for the "C" and end up saying, "Tat."

Inconsistency: The sound errors produced are often inconsistent. If an individual with AOS uses the word substitution of tat instead of cat in one instance, the next time they try the word, cat it may come out as, sat.

However, there may be specific sounds or words that can be consistently difficult to articulate correctly.

Knowing what to say: As stated previously, the person with verbal apraxia knows what they want to say, but has difficulty sequencing the messages sent from the brain.

In pure apraxia of speech (no other accompanying disorders), comprehension of speech and language is intact.

Awareness of errors: As an apraxic individual struggles to produce fluent speech, they are fully aware of the articulation errors they are making.

Speech difficulties resemble stuttering: Because the person has difficulty planning their oral muscle movements their speech patterns are often mistaken for stuttering.

The common features include; difficulty initiating speech, groping for words, hesitations, and unusual oral postures.

Another common feature with stuttering involves the anticipation of errors. If a long response is expected, the person may begin worrying about the accuracy of their response before they start speaking.

This nervous anticipation can cause an increase in articulation errors.

Errors increase as speech demands increase: In other words, one syllable words are easier to say than three, four, or five syllable words.

This is also true for sentence length. Short sentences will usually have fewer articulation errors than longer, more complex sentences.

Spontaneous speech is usually fluent: As stated earlier, when an automatic response occurs it frequently contains few, if any, articulation errors. This is due to the lack of planning required to produce spontaneous speech.

Can accompany other disorders: Apraxia doesn't always occur in isolation. It typically develops in combination with oral apraxia, dysarthria (oral muscle weakness), expressive aphasia (expressive language disorder), or receptive aphasia (receptive language disorder).

Severe apraxia of speech: Occasionally, in severe cases of verbal apraxia an individual might be unable to produce any sounds at all. An alternative means of communicating should be introduced as soon as possible.

Preparing Oral Muscle Movement

When you are ready to speak there are a series of actions that need to take place. First, your brain will choose and organize the words you want to say. Then your brain will send messages to your oral muscles telling them how to move so you can speak those words.

These messages explain how each individual tongue, lip and jaw muscle will move in order to articulate the words you chose to say.

If the messages get through then you will speak the words you planned to say. However, if you have AOS, the messages will become interrupted or distorted.

This interruption will lead to groping for words, which in turn, affects the ability to accurately articulate.

Spontaneous Muscle Movement

Here's an interesting fact about verbal apraxia: it doesn't effect unplanned oral muscle movement. In other words, if you yell out something in anger you will almost always articulate it perfectly. You know, like cursing?

That's because your brain didn't plan out how it was going to move your oral muscles. Your outburst was so well learned that it didn't have to be processed by the brain.

It's sort of like riding a bike. Once you've learned you really don't have to think about it anymore. You just get on and start pedaling!

Learned Phrases and Rehearsed Topics

These involuntary speaking responses can also be extended to phrases and even longer passages, like song lyrics or well known prayers.

It is puzzling for a caregiver to see a loved one that has difficulty with oral motor planning to recite a song or prayer without any trouble.

How can this be?

The reason is that the phrases or longer passages that are being easily spoken have been repeated so many times throughout life that they have actually become "involuntary" actions.

For example, usually no rehearsal or planning is necessary to recite the words to, "Happy Birthday," or the prayer, "Hail Mary." This unusual aspect of AOS is what makes it very frustrating to those who are affected by it.

Learn more about apraxia of speech on our Verbal Apraxia Page.

Using Effective Treatment

Successful treatment of speech disorders starts with a speech and language evaluation. Once a comprehensive examination is completed an appropriate treatment plan can be put into action.

The treatment plan for verbal apraxia will typically consist of two types of therapy: Oral Motor Therapy and Speech Therapy.
Oral Motor Therapy: This type of therapy is used to improve the coordination of oral muscles involved with speaking.

This will consist of tongue, lip, and jaw exercises all geared towards gaining better control over these muscles.

Speech Therapy: This is the traditional therapy most people are familiar with. The exercises and strategies used here will help increase an individual's ability to speak clearly.

In the case of AOS, a speech pathologist will employ articulation drills ranging from easy to very challenging (depending on the severity level of each patient).

They may begin with one syllable words and then progress to longer words, then phrases, sentences, and eventually spontaneous dialogue.

How can you Increase Improvements?

The best way for you to make the greatest improvements is through intensive therapy.

Intensive therapy means practicing speech exercises several times each day. It's that simple and at the same time, it's that hard. It takes motivation, effort, and perseverance.

The good news is that if you're willing to give speech rehabilitation your best shot, then we have the professional speech exercises you need to succeed:

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All the professional activities used to remediate apraxia of speech in clinics, hospitals, and private therapy can now be yours.

Use them anytime you want, as much as you want, and practically anywhere you want.

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