Apraxia Of Speech In Adults - Causes, Symptoms, And Treatment
Author: Roselyn Mathew, Reg. CASLPO, Speech-Language Pathologist
Date: Wednesday, March 05, 2025
Table of Contents
Introduction
Apraxia is a neurological condition, where a person is unable to do a task intentionally, even though they do not have any muscle weakness or incoordination. Apraxia is caused due to damage in the areas of the brain that are responsible for motor planning and motor execution. Because of this, people with Apraxia find it difficult to perform a task when instructed.
Types of Apraxia
There are different types of Apraxia. Some of the common types are:
Orofacial Apraxia
This is an inability to intentionally move the muscles in the face even though there is no muscle weakness. It mainly affects the cheeks, tongue and lips.
Apraxia of Speech
This type of Apraxia makes it difficult for a person to speak with proper enunciation. Words and sounds might get substituted and omitted during speech. Even paralinguistic aspects of speech could get affected along with speech.
Ideational Apraxia
A person with Ideational Apraxia would find it difficult to sequence different steps in a movement or task. They tend to do tasks in an incorrect order.
Ideomotor Apraxia
It is the inability to do a known task on command, but being able to do it in a natural setting or situation. For example, a person might not be able to pretend to comb their hair when asked, but would be able to easily comb their hair when they are given a comb.
Constructional Apraxia
It is the difficulty to copy or draw shapes or objects and to arrange things in a particular order. Here, the visuospatial organizational skills of a person are affected.
Gait Apraxia
In Gait Apraxia, the initiation and coordination of walking are affected. The person might walk with shuffling movements due to this. It is often seen in neurodegenerative disorders.
Oculomotor Apraxia
Oculomotor Apraxia is difficulty in moving eyes intentionally. The vision of the person is usually normal and when they are instructed to look at a particular object or direction, they might change their head position to look instead of moving their eyes.
Limb-Kinetic Apraxia
Here, the coordination and dexterity get affected and the person would find it difficult to perform fine motor movements.
In this article we will be focusing on Apraxia of Speech, it’s causes, symptoms and treatment.
Apraxia of Speech
Apraxia of Speech is a disorder, where a person finds it difficult to program speech motor movements. A well-known definition of Apraxia of speech given by Darley, Aronson and Brown is “A disorder of motor programming for speech production, characterized by inconsistent articulation errors, increased difficulty with longer or more complex words, and disrupted prosody, despite normal strength and coordination of speech musculature.”
There are 2 types of Apraxia of Speech, which are:
Childhood Apraxia of speech
This is a developmental speech disorder. It is usually seen since birth and there is often a speech delay observed in this type of Apraxia. If not treated, this condition can persist into adulthood. Usually, there are no issues in understanding, knowing what to speak, silent reading and writing, unless it co-occurs with other disorders like Autism Spectrum Disorder (ASD) or Attention Deficit Hyperactivity Disorder (ADHD).
Acquired Apraxia of Speech
This type of Apraxia often happens after neurological damage like a head injury, stroke or neurodegenerative diseases. The individual usually has normal speech and language skills before the neurological damage.
Causes of Apraxia of Speech
Some of the most common causes of apraxia of speech are:
Genetic
It has been suspected that childhood Apraxia of Speech can be hereditary as cases of apraxia running in families have been reported. Apraxia of speech has been associated with genetic disorders like FOXP2 gene mutations. But no specific gene related to Apraxia of Speech has been established so far.
Stroke
Stroke is known to be the most common cause for Apraxia of Speech. Stroke may also cause other speech issues along with apraxia like Aphasia or Dysarthria.
Tumors in the brain
The growth of a tumor in the brain can cause apraxia of speech depending on the site of the tumor. If it is close to or in the areas responsible for speech motor movements, it might lead to Apraxia of Speech and may or may not cause other issues in speech and language, depending on how much the tumor grows or spreads.
Neurodegenerative disorders
Neurodegenerative disorders like Alzheimer's and Parkinson’s disease could cause Apraxia of Speech along with other speech and language disorders.
Symptoms of Apraxia of Speech
The most common symptoms are:
Delay in initiating responses
Since a person with Apraxia of Speech has to focus on the speech motor movements to speak, they would take a longer time to initiate a response.
Decreased rate of speech
As it is difficult to have precise speech movements, individuals with Apraxia of speech would have a slower speaking rate.
Unaffected/less affected automatic speech
Automatic speech is the speech that we have without thinking. Saying words like sorry, thank you etc. or any words that they say frequently, might come easily for people having Apraxia of Speech. This is because only the area specific for programing of speech movements are affected.
Inconsistent errors in speech sounds
In Apraxia of speech, the errors are highly inconsistent. Sometimes, there might not be any errors when a sound or a word is produced in an automatic speech. The same sound or word might be produced with errors, and the errors might keep varying depending on the context, the situation and the words/sounds that precede or succeed that sound or word.
Groping movements
Groping movements are the movements seen in articulators- tongue, jaw movements, lips, palate etc., while attempting to position them in order to say a sound or a word. These movements are slow and are more like trial-and-error movements when a person tries to position their mouth to say a word or sound. This is a characteristic sign of Apraxia of Speech. This happens because the brain is unable to program the movements of the articulators while speaking.
Increased difficulty with longer words
People with Apraxia of Speech have more difficulty saying longer words compared to shorter words. As the word length increases, the amount of brain signals sent by the brain to the muscles for motor movement increases. Due to this, it becomes more difficult to enunciate longer words. There are also higher chances of errors for longer words compared to shorter words.
Inappropriate word/sound stress and intonation
Along with sound/word errors, errors in tone of speech as well as inadequate or excessive word/sound stress can be seen in Apraxia of Speech.
Unclear speech
Due to groping movements, inappropriate sound stress and errors in enunciation, the speech clarity is reduced.
Inappropriate pauses between words
Due to errors in programming speech motor movements, there might be an increase in the duration of pauses in between words. There might also be shorter duration of pauses after sentences.
Sound/word omissions and substitutions
Different words or sounds than the actual sounds or words might be said. For example, instead of saying ‘look’, a person with Apraxia of speech might say ‘book’ or ‘see’. Sounds of a word might also be omitted. For example, instead of saying ‘television’, they might say ‘telesion’.
Difficulties in repeating or imitating sounds or words
A person with Apraxia of Speech might find it difficult to imitate a sound or a word. This is because imitating is an intentional process, and we can repeat a word even if we don’t know its meaning. Repeating; especially non-meaningful words require a higher amount of programming. Since programming is affected in Apraxia of Speech, it is much more difficult to repeat a word.
Treatment of Apraxia of Speech
Apraxia of Speech is primarily treated by speech therapy. A Speech Language Pathologist assesses the person’s speech and their speaking situations and works on specific techniques that could help in improving speech.
An alternative approach is using Augmentative and Alternative communication (AAC) devices to improve communication skills. AAC devices are generally used along with speech therapy, but can also be used without speech therapy depending on the severity and the general condition of the person.
Another treatment that is still being explored, is by using techniques that stimulate the brain. The brain can be stimulated by using transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). The idea behind using these methods is to increase the neural plasticity of the brain, which helps in adaptation to the injuries or impairments of the brain. This method is still being researched to understand how effective it would be for a person with Apraxia of Speech to improve their speech and communication.
Conclusion
Apraxia of Speech is a motor speech disorder which is caused due to poor motor programming. It can co-occur with other speech and language disorders or manifest independently. It is important to get assessed and undergo treatment from a professional for having a good speech and communication.
To speak with a psychotherapist or one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.
