What is Apraxia – Causes, Symptom, and Treatment

Apraxia is a rare neurological disorder affecting one’s speech-producing capacity, posing physical challenges in moving facial muscles. People with apraxia of speech (AOS) must visit a speech pathologist equipped with methods for developing speaking skills over time.

The preliminary signs appear when a child is learning to talk. If the symptoms are identified to be present, then chances are there that the child may have suffered a previous brain injury or have underlying tendencies of dementia.

Depending on the age when the signs of apraxia start appearing, this disorder can be divided into two types:

1. Acquired apraxia: Adults develop the symptoms of this disorder once their brain cells start getting damaged due to trauma or complications like a tumour.
2. Childhood AOS: It is a defective birth condition that results in a child's sound and word learning hindrances. Children living with apraxia usually manifest far greater abilities in assimilating conversations than in summarising them and effectively communicating with others.

Neurologists have pointed out numerous common symptoms while examining adult patients diagnosed with apraxia. These include the following:

• Problems faced while arranging syllables in the proper order; at times, individuals fail entirely in doing so
• Difficulty noticed while pronouncing complex words
• Increased tendency to use nonverbal communication forms like gestures
• Speech inconsistency, this means a person can correctly pronounce specific words most times but find difficulty in spelling them out at certain moments
• Speech distortion while using vowels
• Occasional struggle while forming words

Childhood apraxia is often paired with other cognitive issues like dementia. Some problems that the youngest of children and babies with this health hazard experience are as follows:

• Clumsiness
• Limited words are spoken to express feelings
• Frequent grammatical errors
• Difficulty in developing refined motor skills

The causes of acquired apraxia and childhood apraxia are different. Thus we have listed them separately.

Acquired Apraxia Causes

Acquired apraxia may affect any individual irrespective of their age. A person may develop symptoms of this ailment if parts of their brain get damaged because of an injury resulting in compromised decision-making capabilities. 

• Traumatic head collision
• Underlying neurodegenerative conditions
• Surgical trauma
• Brain tumour
• Stroke

Childhood Apraxia Causes

Though medical researchers have not been able to determine the exact causes of childhood apraxia, most believe this disorder is a part of a much larger cognitive deficit. However, its genetic probability has not been completely ruled out.

Boys are more prone to develop symptoms of childhood apraxia. Most diagnosed individuals belong to a family where somebody or the other struggled with a learning disability at some point in their life.

Chalking out a definite conclusion on who is at risk for developing apraxia is complex. This is because the symptoms of this disorder may not be visible to anyone. However, medical experts have seen a greater tendency of AOS among certain groups globally. We have listed a couple of groups below:

• Children between 2 and 4 years of age are prone to developing symptoms of childhood apraxia of speech.
• Adults in their mid-30s and 40s can develop situations where they find it difficult to communicate due to the underlying effects of this disorder.

A speech pathologist cannot prescribe one single medical test to identify the root cause of apraxia of speech. Hence, a concerned individual must undertake a group of tests that will again depend on the set of symptoms they are progressively developing.

Apart from evaluating the patient’s past medical records, the speech-language pathologist (SLP) will also examine other underlying conditions. These include examining the chances of the patient developing:

• Muscle weakness
• Hearing disorder
• Aphasia

Diagnostic procedures are bound to vary depending on the patient's age group. For instance, when a child visits the SLP, the delegated practitioner will follow these procedures:

• Evaluate how well the child can express his/her thoughts to others outside their family members.
• Assess how comfortably and precisely the child can spell out specific vowel and consonant sounds.
• Ask a child to repeat pronouncing a syllable multiple times to notice speech patterns.
• Ask the child to read out loud a pre-set list of long words.
• Assign hearing tests to see whether the child is suffering from active hearing deficits.

SLPs follow the below-listed set of procedures for adults who have suffered a brain injury to determine whether they may develop speech apraxia:

• Ask the patient whether they are facing problems while communicating in their known languages.
• Request the patient to pronounce a few syllables which they otherwise would find difficult to spell out if they had symptoms of the disease.
• Evaluate if there is any noticeable voice change by conducting tests and enquiring about the patient’s family members.
• Evaluate the patient’s knowledge-grabbing capacity.
• Look for signs of muscle weakness by examining the concerned individual’s jaw, tongue and lips.

As a greater part of the diagnostic process, the therapist may assign some nonverbal, writing and reading tasks to the person visiting them.

Depending on whether the patient is an adult or a child, speech pathologists prescribe a specific apraxia therapy to cure speech-forming difficulties. Here are some of the commonly suggested exercises by medical experts:

• Repeatedly practise spelling out a group of syllables.
• Pronouncing complex words multiple times helps doctors to evaluate signs of speech inconsistency.
• Observing and replicating proper mouth movement shown by the therapist while speaking.

People with primary progressive apraxia of speech show better survival tendencies when compared to those suffering from a combination of AOS and progressive agrammatic aphasia.

For instance, doctors found the median survival for people with progressive apraxia to be 5.26 years as per NCBI, while the statistic dropped to 4.33 years for patients with AOS + PAA. But prognostic estimations may change vastly depending on the treatment effectiveness and quality of family support.

Communication hindrance due to apraxia of speech can be cured up to a remarkable extent with consistent neurological support and efforts. Though it may be challenging to start, here are some tips that will definitely help people with AOS to recover over time:

• Break long words into small parts while pronouncing.
• Thinking before speaking and speaking slowly.
• Learn nonverbal ways to communicate and use them whenever it is a necessity and not get used to them all the time.
• Practise singing as melody helps to articulate longer words more easily.
• Avoid any crucial conversation while emotional stability is not on point.
• Use an augmentative communication tool when it is difficult to express the thought or write down the message that needs to be conveyed.

Even though there are no known ways to prevent the disorder entirely, improvement of the speech-producing abilities through regular therapies and family support is evident. Parents can minimise the child’s chances of developing the symptoms by insisting they read more books and engaging them in frequent conversations. In comparison, therapists play the most crucial role in the diagnosis of apraxia in mid-aged adults.