Apraxia of speech: types, symptoms, causes and treatment

Apraxia of speech is an acquired disorder of neurological origin in which the person’s ability to produce sounds and language in a coherent and intelligible manner is altered, because the rhythm, intonation or speed of speech is altered.

In this article, we will see what this disorder is, what are the main types of speech apraxia and its symptoms, as well as the different treatments available.

    What is apraxia of speech?

    The term “apraxia” is used today to refer to poor motor programming of speech. It was the doctor and anatomist Paul Broca who first mentioned this concept in the middle of the 19th century.. This disorder is a consequence of damage to the left cerebral hemisphere.

    Apraxia of speech is a neurological disorder related to language that causes alterations in articulation and prosody (elements of oral expression such as accent or intonation). Evidence suggests that this condition is the result of injury to the third frontal gyrus of the dominant hemisphere (in the Broca region) or the Brodmann region 44 and 45. It has also been pointed out that the basal ganglia could have similar speech programming functions.

    This type of injury they can be caused by trauma, tumors, degenerative diseases and other murderous disorders, Although the most common etiology is usually stroke. Brain damage usually occurs in the parietal lobes or adjacent areas, with the preservation of learned movement patterns.

    Less commonly, apraxia of speech results from damage to other areas of the brain, such as the premotor cortex (located just in front of the motor cortex), other areas of the frontal lobe or the corpus callosum; there may also be a diffuse involvement linked to degenerative dementias.

    Types of apraxia of speech

    There are two main types of apraxia of speech: acquired apraxia of speech and apraxia of speech in children. Let’s see what each of them consists of.

    Acquired speech apraxia

    This type of apraxia of speech can occur at any age, although it usually affects adults. This specific type of apraxia occurs as a result of injuries to areas of the brain involved in speech and results in loss or impairment of oral skills. It can be the result of a stroke, head trauma, tumor, or any other disease that affects the brain.

    In addition, this type of speech apraxia it can occur with other disorders affecting the nervous system, Such as: dysarthria, a disorder characterized by difficulty in articulating sounds and words, caused by paralysis or ataxia of the nerve centers that control the speech organs; or aphasia, a language condition that consists of a difficulty or inability to communicate by speaking, writing or miming, due to brain damage.

    Apraxia of children’s speech

    This type of apraxia is present from birth. Apraxia of speech in children is not the same disorder as delayed speech development, in which the child develops normal speech but more slowly. In apraxia, children have difficulty planning the movements necessary to produce speech.

    While the muscles involved in the speaking process are not weak, they do not function as they should. because there is an obvious difficulty in directing or coordinating the movements. However, the causes of this disorder are still not fully understood, as studies and neuroimaging tests have not been able to find evidence of brain damage or differences in the brain structure of these children.

    It is common for children with apraxia of speech to have a family member with a history of communication disorder. or some kind of learning problem. For this reason, some researchers have suggested that genetic factors could play an important role in the development of the disease. It should also be noted that gender would be an equally significant variable, as this type of apraxia tends to affect boys more than girls.

      characteristic symptoms

      There are a number of characteristic symptoms in people with apraxia of speech. Again they can vary depending on the age and severity of the disorder and speech problems, the most common are:

      The person does trial and error and then tries to correct themselves.

      • There is an articulatory inconsistency about repeated productions of the same utterance (the person cannot articulate sounds well even if they try several times).
      • Prosody errors occur (in stress, intonation and rhythm).
      • Inconsistency errors occur in speech (for example, the person says a word well but cannot repeat it).
      • There is distortion in the sounds and difficulty pronouncing words correctly (due to the inability to place the orofacial muscles properly).
      • The person has trouble initiating a statement (hesitates when starting to articulate the first words).

      treatment

      The goal of treatment for apraxia of speech is to get the patient to communicate effectively.; therefore, what the professional pursues is to restore, as far as possible, the patient’s speech, that is to say, it becomes functional even if it is not possible to bring the person back to the levels of communication that existed before. of disorder.

      Currently, there is a consensus that there are five categories of treatment for apraxia of speech: kinematic articulation; rate and / or rate based treatment; alternative and / or augmentative communication; inter-system facilitation and reorganization; and other treatments.

      Kinematic articulatory treatment focuses on the treatment of joint problems, focusing on the spatiotemporal aspects of speech production. As for the methods based on speed and / or rhythm, their method is based on the treatment of the alteration that patients present in the times of speech production, helping them to control the rhythm in order, in this way, to recover. temporal patterns of speech.

      As for alternative and augmentative communication, Are two forms of intervention that aim to improve communication through the use of modalities different from the traditional use of speech. Some activities of this method involve the use of symbols, communication drawings and boards, computer programs, etc.

      Finally, with regard to intersystem facilitation and reorganization techniques, it should be noted that these methods include the use of intact systems and modalities in the patient to facilitate the implementation of other modalities and modified systems; for example, through the use of gestures or graphic stimuli that facilitate speech, singing familiar melodies, etc.

      Bibliographical references:

      • R. González Victoriano and L. Toledo Rodríguez, “A Speech Apraxia: Evaluation and Treatment”, 2015. [En línea]. Available: http://repositorio.uchile.cl/handle/2250/134234
      • Ygual-Fernández A, Cervera-mérida JF. Verbal dyspraxia: clinical features and speech therapy. Rev Neurol. 2005; 40: 121-26

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