Apraxia: What Causes Difficulty Initiating Speech and How is it Treated?

Among various motor disorders caused by any damage in the brain is a motor disorder known as Apraxia. There are various forms of Apraxia, and one of the forms is Apraxia of Speech or Verbal Apraxia where the person affected meets with a difficulty in initiating speech. In this current article we will talk about the same where we will discuss on what causes difficulty initiating speech and how is it treated.

Apraxia is an acquired motor disorder which is specifically caused by damage in the posterior parietal cortex of the brain where the affected child or affected person suffers from difficulty with proper motor planning. Though the person affected by this motor disorder may have difficulties in motor planning to perform certain tasks or movements when asked for; he or she may not have a sensory loss or may not fail to comprehend simple commands in Apraxia. Milder forms of Apraxia are known as Dyspraxia.

There are various forms of Apraxia and one of the forms is Apraxia of speech where the victim meets with difficulty in initiating speech. Occulomotor Apraxia, Ideomotor Apraxia, Ideational Apraxia, Constructional Apraxia, Gait Apraxia, Bucofacial Apraxia etc are some other forms of Apraxia. However, leaving apart all these forms of Apraxia we will talk about the form of Apraxia where there is a difficulty in initiating speech or the Verbal Apraxia or Apraxia of Speech in this article.

In case of Apraxia of speech the affected person or child finds it difficult or almost impossible to initiate speech as he or she is unable to move the mouth and tongue to speak. It must be noted that the patient has the desire to speak and also he or she has normal mouth muscles that are physically able to form words. However the problem in initiating speech occurs because the messages from the brain to the mouth are disrupted in case of Apraxia of speech. This makes it difficult for him or her to move the lips or tongue to the right place to correctly say sounds.

Apraxia or the form of apraxia where there is a difficulty in initiating speech; is sometimes confused with another communication disorder known as Aphaxia. However there are some significant differences between the two. In case of aphaxia, the affected person has a problem in understanding or using words appropriately. This is the reason which may make the person hard to speak, write or read. But, in case of people with Apraxia of speech there is no problem with language comprehension and it is described only by difficulty initiating speech because of some damage occurred to the brain and where the connection between the brain and the mouth is disrupted.

The form of Apraxia known as Apraxia of speech is also known by the name Verbal apraxia. Based on its severity, it may range from mild to severe.
There are various causes of Apraxia; and most importantly people who suffer from strokes and dementia, are likely to have greater risks of Apraxia. Though there are no appropriate data existing that concerns about the occurrence of Apraxia in different age groups; there are evidences that it is more common in older people as they have greater frequencies of dementia and strokes.

Below are some of the symptoms of Apraxia or the state where the affected person meets with difficulty in initiating speech.

• Distorted, left out or repeated speech sounds or words are experienced in the person affected with Apraxia.
• There are symptoms of difficulty in putting words together in appropriate order, experienced by the affected person.
• The person may show symptoms of struggling to pronounce the right word in case he or she has apraxia.
• People with Apraxia or difficulty in initiating speech have better ability to write than to speak.
• The affected person may show symptoms of difficulty in using longer words sometimes or all the times.
• People with Apraxia are likely to make inconsistent mistakes while speaking. However, they are aware of their mistakes while speaking.
• At times, the person may use completely different word or action than to something they actually intend to use.
• One of the common symptoms noted in children with Apraxia of speech is that, usually they are able to understand language much better than they are able to make use of them to express themselves.
• In mild cases of Apraxia of speech the affected person has only trouble with sounds of very few speech or words and has only occasional problems in effectively pronouncing words with many syllables. However in severe cases, the affected person may fail to communicate effectively with speech and may require the helps of any other alternative modes of communication.

There are two main types of Apraxia where there is a difficulty initiating speech:

1. Acquired Apraxia of Speech: This is the type of apraxia where there is a difficulty in initiating speech and is caused by damage to the parts of the brain which are involved in speaking and which involves the loss or impairment of existing abilities of speech. Though this type of acquired apraxia affects mainly adults, this may also affect a person of any age. A stroke, tumor, injury to head or any illness affecting the brain, can result in such a type of apraxia or the motor disorder where the patient has difficulty initiating speech. It must be noted that Acquired type of apraxia of speech may occur together with other conditions like dysarthria, where there is muscle weakness in the affected patient that affects the production of speech, and Aphasia, where there are difficulties in language and is caused by damage to the nervous system.
2. Developmental Apraxia of Speech: This is the type of Apraxia of Speech which is mainly present in Children and is noticed from their birth. Developmental Apraxia mainly appears to affect boys more than girls. Developmental Apraxia of Speech is also known as Developmental Verbal Apraxia, Articulatory Apraxia, childhood Apraxia of Speech etc.

Apraxia is primarily caused by any damage to the brain. Some of the most common causes for acquired apraxia may be brain tumor, traumatic injury to the brain, stroke, dementia or any neurogenetic illness. However, the exact causes for developmental apraxia of speech are not yet known.

Here let us take a look at some possible complications because of Apraxia or the condition causing difficulty in initiating speech.

• Affected person may have severe learning problems
• There may be low self-esteem seen in the affected child or person
• There may be issues in socialisation or may have social problems.
• People with Apraxia of speech who may have their difficulty in initiating speech due to dementia may grow some secondary nutritional deficiencies.

Below are some tests which may be performed by the doctor in order to diagnose the disorder of Apraxia where you might have difficulty in initiating speech.

• CT scans or MRI scans of the patient’s brain will help show a stroke, tumor or any other brain injury.
• An EEG or Electroencephalogram may rule out epilepsy as a cause of the Apraxia experienced in the person.
• In order to check for the presence of any inflammation or infection that might have affected the brain, a spinal tap may be performed.
• Standardized language and intellectual tests must be done in case there is apraxia of speech. It is also essential to test for other learning disabilities.
• Diagnosis of apraxia where there is difficulty initiating speech, must be done by professionals known as speech-language pathologists.
• Professionals would look for various symptoms in the affected person or child and parents would require observing the child’s speech over a period of time.
• For testing acquired apraxia of speech, the professional would examine the affected person’s ability to converse, read, write and also check the ability to person non-speech movements.
• For testing developmental apraxia of speech, the speech language pathologist may ask the patient to perform speech tasks like repeating a particular word certain number of times or repeating a list of words in the increasing length, like faith, faithful, faithfully; love, loving, lovingly etc.

Here we will take a look on the treatment method which can help get rid of the problem of initiating speech. But prior to that we must mention that there is something called spontaneous recovery. This Spontaneous recovery in Apraxia of speech in a person belongs to the natural and gradual way of recovery from the condition in case of Acquired type of Apraxia of speech. Here, people with acquired apraxia of speech recover some or even all of their abilities for speech on their own. That is the reason it is known as spontaneous recovery.

Speech language therapy is actually the treatment procedure used to treat apraxia of speech in children or people who will not be able to outgrow their problem in initiating speech of their own. Usually children with developmental apraxia of speech will not outgrow their problem on their own and also some people with acquired apraxia of speech also cannot have spontaneous recovery of the speech problem. This therapy is performed by an expert speech language pathologist who uses various approaches to treat apraxia of speech. The therapy is tailored to the individual and each person with apraxia of speech may respond differently to the therapy.

Following may be included in a speech and language therapy:

• Repeating sounds over and over so as to teach the affected person mouth movements.
• Teaching various techniques to help him or her communicate effectively. In severe cases of Apraxia where the patient has serious difficulties in initiating speech; they may require using other ways to express themselves which may include formal or informal sign language, a language note with pictures or words that can be presented by the person to others for expressing something or a portable computer that writes and produces speech etc. The therapist will train about the same.
• Slowing down the speech of the person affected with Apraxia or difficulty in initiating speech
• People with severe cases of speech and language issues in Apraxia may also grow up with depression. So, it is important to recognize and treat depression and is included under the therapy.

Apart from the therapy, appropriate support and encouragement from family and friends are highly essential to come out of the problem of initiating speech in Apraxia.

Usually, patients with Apraxia get dependent for their daily activities and may require at least some degree of supervision from near ones; and also some skilled nursing care may be required in some cases. People who have apraxia because of any degenerative disease or tumor may develop in to more dependence. Patients with strokes may have a stable course and may even show improvement in their condition. It is studied that if Apraxia of speech or condition where there is difficulty initiating speech; is persistent for more than a year then it is associated with larger volume of left hemispheric stroke which involve the Broca area.

• Maintain a calm and relaxed environment around.
• Be patient and take time to show the affected person on how to do a task and also allow him or her enough time to do the same.
• Do not give complex directions to people who suffer from apraxia of speech or who have difficulty in initiating speech.
• Make use of simple phrases so as to avoid misunderstanding
• Be sure that people with speech apraxia do not have a hearing problem. So speak in a normal tone of voice whenever conversing with an affected person.
• Do not assume that the person understands everything you say.
• Provide them some communication aids if possible at your end so that they can express them correctly.

As they say, “Every problem has a solution with it!” if you or any of your known one has Apraxia where he or she has difficulty in initiating speech be very sure you make a visit to an expert speech and language pathologist and get the appropriate treatments for the same. It is well and good in case the condition is treatable; and even if the treatment for any individual does not work it is also obvious that the techniques he or she learns from the therapist would surely help him or her communicate well with others. Above all, kindly support, encourage and take very good care of your dear ones who has issues initiating their speech or who suffers from apraxia.

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