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What Is Apraxia of Speech?
Apraxia of speech, also known as verbal apraxia or dyspraxia, is a
speech disorder in which a person has trouble saying what he or she
wants to say correctly and consistently. It is not due to weakness or
paralysis of the speech muscles (the muscles of the face, tongue, and
lips). The severity of apraxia of speech can range from mild to severe.
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What Are the Types and Causes of Apraxia?
There are two main types of speech apraxia: acquired apraxia of speech
and developmental apraxia of speech. Acquired apraxia of speech can
affect a person at any age, although it most typically occurs in adults.
It is caused by damage to the parts of the brain that are involved in
speaking, and involves the loss or impairment of existing speech abilities.
The disorder may result from a stroke, head injury, tumor, or other
illness affecting the brain. Acquired apraxia of speech may occur together
with muscle weakness affecting speech production (dysarthria) or language
difficulties caused by damage to the nervous system (aphasia).
Developmental apraxia of speech (DAS) occurs in children and is present
from birth. It appears to affect more boys than girls. This speech disorder
goes by several other names, including developmental verbal apraxia,
developmental verbal dyspraxia, articulatory apraxia, and childhood
apraxia of speech. DAS is different from what is known as a developmental
delay of speech, in which a child follows the "typical" path
of speech development but does so more slowly than normal.
The cause or causes of DAS are not yet known. Some scientists believe
that DAS is a disorder related to a child's overall language development.
Others believe it is a neurological disorder that affects the brain's
ability to send the proper signals to move the muscles involved in speech.
However, brain imaging and other studies have not found evidence of
specific brain lesions or differences in brain structure in children
with DAS. Children with DAS often have family members who have a history
of communication disorders or learning disabilities. This observation
and recent research findings suggest that genetic factors may play a
role in the disorder.
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What Are the Symptoms?
People with either form of apraxia of speech may have a number of different
speech characteristics, or symptoms. One of the most notable symptoms
is difficulty putting sounds and syllables together in the correct order
to form words. Longer or more complex words are usually harder to say
than shorter or simpler words. People with apraxia of speech also tend
to make inconsistent mistakes when speaking. For example, they may say
a difficult word correctly but then have trouble repeating it, or they
may be able to say a particular sound one day and have trouble with
the same sound the next day. People with apraxia of speech often appear
to be groping for the right sound or word, and may try saying a word
several times before they say it correctly. Another common characteristic
of apraxia of speech is the incorrect use of "prosody" --
that is, the varying rhythms, stresses, and inflections of speech that
are used to help express meaning.\
Children with developmental apraxia of speech generally can understand
language much better than they are able to use language to express themselves.
Some children with the disorder may also have other problems. These
can include other speech problems, such as dysarthria; language problems
such as poor vocabulary, incorrect grammar, and difficulty in clearly
organizing spoken information; problems with reading, writing, spelling,
or math; coordination or "motor-skill" problems; and chewing
and swallowing difficulties.The severity of both acquired and developmental
apraxia of speech varies from person to person. Apraxia can be so mild
that a person has trouble with very few speech sounds or only has occasional
problems pronouncing words with many syllables. In the most severe cases,
a person may not be able to communicate effectively with speech, and
may need the help of alternative or additional communication methods.
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Apraxia of Speech may result from stroke
How Is It Diagnosed?
Professionals known as speech-language pathologists play a key role
in diagnosing and treating apraxia of speech. There is no single factor
or test that can be used to diagnose apraxia. In addition, speech-language
experts do not agree about which specific symptoms are part of developmental
apraxia. The person making the diagnosis generally looks for the presence
of some, or many, of a group of symptoms, including those described
above. Ruling out other contributing factors, such as muscle weakness
or language-comprehension problems, can also help with the diagnosis.
To diagnose developmental apraxia of speech, parents and professionals
may need to observe a child's speech over a period of time. In formal
testing for both acquired and developmental apraxia, the speech-language
pathologist may ask the person to perform speech tasks such as repeating
a particular word several times or repeating a list of words of increasing
length (for example, love, loving, lovingly). For acquired apraxia of
speech, a speech-language pathologist may also examine a person's ability
to converse, read, write, and perform non-speech movements. Brain-imaging
tests such as magnetic resonance imaging (MRI) may also be used to help
distinguish acquired apraxia of speech from other communication disorders
in people who have experienced brain damage.
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How Is It Treated?
In some cases, people with acquired apraxia of speech recover some
or all of their speech abilities on their own. This is called spontaneous
recovery. Children with developmental apraxia of speech will not outgrow
the problem on their own. Speech-language therapy is often helpful for
these children and for people with acquired apraxia who do not spontaneously
recover all of their speech abilities.
Speech-language pathologists use different approaches to treat apraxia
of speech, and no single approach has been proven to be the most effective.
Therapy is tailored to the individual and is designed to treat other
speech or language problems that may occur together with apraxia. Each
person responds differently to therapy, and some people will make more
progress than others. People with apraxia of speech usually need frequent
and intensive one-on-one therapy. Support and encouragement from family
members and friends are also important.
In severe cases, people with acquired or developmental apraxia of speech
may need to use other ways to express themselves. These might include
formal or informal sign language, a language notebook with pictures
or written words that the person can show to other people, or an electronic
communication device such as a portable computer that writes and produces
speech.
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What Research Is Being Done?
Researchers are searching for the causes of developmental apraxia of
speech, including the possible role of abnormalities in the brain or
other parts of the nervous system. They are also looking for genetic
factors that may play a role in DAS. Other research on DAS is aimed
at identifying more specific criteria and new techniques that can be
used to diagnose the disorder and distinguish it from other communication
disorders. Research on acquired apraxia of speech includes studies to
pinpoint the specific areas of the brain that are involved in the disorder.
In addition, researchers are studying the effectiveness of various treatment
approaches for acquired and developmental apraxia of speech.
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Where Can I Get Additional Information
Tustin Speech & Language Center
661 West First Street, Suite E
Tustin, CA 92780
Phone: (714)-838-2853
Info@TustinSpeech.com
National Institute on Deafness and Other Communication Disorders
www.nidcd.nih.gov
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Apraxia of Speech
November 2002 |
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