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What is apraxia of speech, or acquried verbal apraxia?
Apraxia of speech (also called verbal apraxia) is a motor speech disorder, setting it apart from aphasia, a language disorder, and dysarthria, a disorder linked to muscle weakness. Unlike dysarthria, verbal apraxia doesn't stem from issues with the muscles involved in speech but rather from disruptions in the brain's message delivery.
When we speak, the brain's message transmits ideas into language then into a sequence of sounds for speech. In verbal apraxia, however, before reaching the muscles that control the lips and tongue for speech coordination, this message goes haywire. It can cause various sound substitutions, from a few syllables to extensive distortions, making the intended message challenging to interpret.
Individuals with apraxia of speech understand what they want to express, yet by the time the message reaches their mouth, it becomes a string of sounds that may be incomprehensible. The frustration of having clear thoughts but producing unintelligible sounds can be profound.
Signs of Acquired Verbal Apraxia
Slower speech with sound distortions
Visible struggle or "groping" during speech
Difficulty imitating sounds or words
Increased difficulty responding to specific requests compared to natural conversation
Ease in singing, counting, or reciting the alphabet, contrasted with difficulty answering questions
Normal response to social phrases or automatic responses
Varied outcomes when repeating the same word or sounds
In severe cases, an inability to produce any sound, even to cough or clear the throat upon request
How Common is Apraxia of Speech?
Apraxia of speech can be acquired following a stroke, head injury or similar neurological condition. There are no reliable data on the incidence of apraxia of speech, according to ASHA (American Speech Language Hearing Association). Some studies have attempted to collect data, but they are small samples, and it is suspected that these numbers are deceivingly low because apraxia rarely happens in isolation and may be overlooked.
Can Speech Therapy Help Verbal Apraxia?
Speech therapy has proven to be a pivotal and effective intervention for individuals grappling with acquired verbal apraxia. Through targeted exercises and personalized strategies, speech-language pathologists work collaboratively with clients to enhance their ability to plan and execute precise speech movements.
The Interplay with Aphasia
The effectiveness of speech therapy lies not only in addressing the motor aspects of verbal apraxia but also in considering the unique challenges posed by its intersection with language deficits, such as those seen in aphasia. As mentioned above, acquired verbal apraxia rarely happens in isolation. It is more commonly seen in people who also have aphasia, a language disorder.
One of the primary challenges in addressing acquired verbal apraxia alongside aphasia is the overlap in symptoms. Individuals may experience difficulty not only in finding the right words (aphasia) but also in articulating them (verbal apraxia). This dual challenge necessitates a comprehensive therapeutic approach.
Tailoring Therapeutic Approaches
1. Comprehensive Assessment
In cases where acquired verbal apraxia coexists with aphasia, a thorough assessment is crucial. Understanding and diffrentiating the specific speech motor challenges and language deficits helps in tailoring interventions that address both aspects of communication impairment.
2. Phonetic Cueing
For individuals dealing with both aphasia and verbal apraxia, incorporating phonetic cueing in therapy sessions can be beneficial. This involves providing visual or tactile cues to guide the correct articulatory movements, aiding in more accurate speech production, as discussed above.
3. Intensive Practice
Given the motor nature of verbal apraxia, therapy requires intensive and repetitive practice to enhance muscle memory and coordination. Integrating these practices into daily communication exercises supports ongoing improvement.
Speech Apps Offer Support
There are effective therapy apps that offer support between therapy visits and contribute to the intensive training and repetition recommended for verbal apraxia. These apps provide visual models and cues for common phrases or simple tasks such as counting or stating the alphabet. An example of an app to consider is Apraxia Therapy by Tactus. There is a free version that will help get a feel for the way the application works. The Speech Flipbook, also by Tactus, focuses on phonetics and costs $9.99. Speech Sounds on Cue is another app to consider.
Speech apps are also helpful for people who have moderate or severe verbal apraxia and benefit from an alternative communication device (AAC). If aphasia is not a complicating factor, a simple speech-to-text app can be utilized to make everyday communication less stressful. These devices work by allowing someone to type out their intended message or use pictures to build a sentence and by pressing a button the computer-generated voice speaks the message. Let me Talk and Talk for Me are examples of simple speech to text applications.
Conclusion
Apraxia of speech is a communication impairment that responds well to speech therapy. The foundations of success lie in the commitment to intensive and repetitive practice. Aphasia can be an additional complication for overcoming apraxia of speech, but an experienced speech language pathologist is skilled in managing both conditions simultaneously to guide therapy and help people with apraxia make signnificant strides in enhancing thier communicatiaon abilities.