May 14, 2013 was the first Apraxia Awareness Day. Many of my colleagues now mark the day annually with blogs and other efforts to educate about the disorder and how SLPs can help. Most of the tweets and blog posts I see focus on Childhood Apraxia of Speech. My interest lies more in assessment, diagnosis, and treatment of adolescents and adults with apraxia following brain injury or stroke. Whether we’re talking about children or adults, I’m sure some of you are probably thinking: What the heck is apraxia anyway?
Apraxia is a motor planning disorder. People with apraxia typically know what they want to do/say and the brain formulates a plan and sends it to the body for action. That’s when the trouble starts. Something interferes with the motor signals sent from the brain.
Apraxia exists in spite of preserved cognition and ability to move affected body parts. Apraxia of speech is not dysarthria — problems pronouncing the sounds of speech — but the disorders may co-exist.
The following are descriptions of different forms of apraxia. Basically, messages get lost/short-circuited between the brain and …
- … the arms and/or legs in Limb Apraxia.
- … the oral structures, e.g. the jaw, tongue, lips, etc. during activities such as eating, drinking, swallowing, speaking in Oral Motor Apraxia.
- … the articulators in Speech Apraxia. (Similar to oral motor apraxia but more specific to speech sound production.)
- … the respiratory system and larynx in Voice Apraxia. (Results in errors producing voiced vs. voiceless phonemes e.g. /b/ vs. /p/; /d/ vs. /t/; /v/ vs /f/; vowels. Negatively impacts coordination of respiration and phonation [vibration of the vocal cords.])
Speech-Language Pathologists treat the communication deficits of apraxia using a variety of strategies and tools. Treatment can be challenging because inconsistent errors are characteristic of the disorder. Sounds or gestures produced and sequenced beautifully one day are impossible to re-create the next and vice versa. People with apraxia know what they want to say, but the instructions to produce it get scrambled between the brain and their articulators. They may have no problem with spontaneous articulation but experience pronounced difficulty when trying to speak/answer on request.
In severe cases, people with apraxia may require training in the use of augmentative and alternative communication (AAC) for safe and active participation in day-to-day activities. AAC may be low-tech using strategies such as gesture or drawing, or it may be high-tech utilizing dedicated speech devices or other electronic aids. AAC applications (apps) for smart phones and tablets such as the iPad or Android based devices are increasingly available.
The wide availability of affordable, increasingly sophisticated AAC tools makes it an exciting time to be a Speech-Language Pathologist serving people with apraxia! If you or a loved one have apraxia, I recommend you request a referral for an evaluation by a Speech-Language Pathologist to learn more about how s/he can help!
Cynthia Williams Bowen, MS, CCC-SLP owns Bowen Speech-Language Therapy, LLC in Clearwater, FL. Cyndee provides quality, creative, collaborative treatment to adults and adolescents with communication, swallowing, Parkinson’s, and related disorders.