Apraxia of Speech

What is Apraxia of Speech?

Apraxia of speech is a type of speech disorder that makes it hard for a person to control the muscles used in speech. Despite having healthy muscles, people with apraxia have trouble planning and sequencing the actions needed for clear speech due to issues in the brain.

Types of Apraxia

Acquired Apraxia of Speech (AOS): often abbreviated as AOS, is a type of speech disorder where a person has difficulty planning and sequencing the movements necessary for speaking. The key term here is "acquired," which means that this condition occurs in individuals who were once able to communicate effectively but have lost this ability due to damage in specific areas of the brain responsible for speech production.

AOS can occur in adults at any age, but it is most commonly observed in adults who have suffered a stroke, or traumatic brain injury, or in those with brain tumors or conditions that cause progressive neurological damage, like certain forms of dementia. Importantly, AOS is not due to weakness or paralysis of the speech muscles. Muscle coordination difficulties are caused by problems in the brain's ability to send the correct signals.

Childhood Apraxia of Speech (CAS): Also known as pediatric apraxia of speech, CAS is a type of motor speech disorder. Children with CAS have trouble saying sounds, syllables, and words because the brain has problems planning to move the body parts needed for speech (like the lips, jaw, and tongue). The child knows what they want to say, but their brain has difficulty coordinating the muscle movements necessary to say those words.

Signs and Symptoms

Inconsistent Errors: Errors in speech vary and are inconsistent. The same word may be pronounced differently at different times.

Difficulty with Longer Words: Longer words tend to pose more challenges, with more errors occurring.

Groping of Speech: A person with apraxia may struggle to make the correct sounds and appear to be groping for the right position with their mouth or tongue.

Challenges with Automatic Speech: Everyday words or phrases may be unexpectedly difficult.

What Does Apraxia Treatment Look Like? 

As mentioned, children with apraxia will not outgrow it on their own, nor will they acquire the basics of speech by being around their peers. 

Apraxia often requires frequent, intensive, one-on-one speech-language therapy sessions, with lots of repetitive exercises and personal attention. Once your speech therapist better understands your child’s condition, they will design a treatment plan tailored to your child’s needs and speech abilities. Treatment may go on for years in addition to normal schooling.

Many children with childhood apraxia of speech benefit from:

• Practicing the repetition of sounds, words, and phrases

• Being shown visually how speech sounds are made by combining sounds into words

• Saying a word at the same time as the speech therapist or parent/caregiver

For adults with acquired apraxia, treatment works similarly. However, some people with acquired apraxia of speech do recover on their own. This is called spontaneous recovery.

Just as individual symptoms vary, so does progress. What works for one child or adult may not work for another, and each person progresses at their own pace. As a parent, caregiver, spouse, or friend, one of the most important things you can do is be a constant source of encouragement and routinely practice at home. 

In severe cases, adults and children with apraxia of speech may need to find alternative ways for communicating and expressing their thoughts. These methods can include:

• Using sign language

• Using a notebook with pictures or written words

• Using an alternative or augmentative communication (AAC) device, such as a communication board or a portable tablet that writes and produces speech

These assistive tools may not need to be used long-term. However, using these modes of communication while working with your speech therapist can help promote speech production and verbal skills. Using an AAC device can also help decrease any frustration a person may feel in trying to communicate.

Treatment for Apraxia of Speech

Dynamic Temporal and Tactile Cueing (DTTC) is a key method in our toolbox for treating Apraxia of Speech.

Dynamic Temporal and Tactile Cueing (DTTC)

DTTC is a therapeutic approach that prioritizes multisensory cueing to help individuals with apraxia of speech improve their motor planning skills for speech.

Here's a brief breakdown of how it works:

1. Hierarchy of Temporal Delay: With DTTC, the therapist starts by providing immediate imitation cues. That means the therapist models a word or phrase, and the patient immediately repeats it. As the patient's skills improve, the therapist increases the delay between the model and the patient's repetition, challenging the patient to rely more on their own motor planning abilities.

2. Multisensory Cueing: DTTC employs a variety of cues to aid speech production, not just auditory. These might include visual cues, like watching the therapist's mouth, and tactile cues, like feeling the therapist's throat vibrate during certain sounds. The aim is to help the patient understand and mimic the movements necessary for speech in a variety of ways.

3. High Repetition and Intensity: DTTC uses a high repetition model, practicing the same words or phrases multiple times in one session. This repetition helps reinforce the motor patterns needed for speech.

4. Progressive Approximations: The therapist starts with targets that the patient can achieve relatively easily and gradually moves towards more complex words or phrases. This progressive model helps build confidence and skills steadily over time.

At Issa Speech Therapy, we use DTTC as part of our individualized treatment plans for apraxia of speech. Our therapists are trained in this method and understand how to adapt it to each patient's unique needs and abilities. Together, we'll work to improve speech and communication, step by step.