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 way is altered, due to altered rhythm, intonation, or rate of speech.

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

• Related article: "The 8 types of speech disorders"

What is apraxia of speech?

The term "apraxia" is now used to refer to deficient motor speech programming. The physician and anatomist Paul Broca was the first to refer to this concept in the mid-19th century.. This disorder is a consequence of the damage produced in 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 a lesion in the third frontal gyrus of the dominant hemisphere (in Broca's area) or Brodmann's area 44 and 45. It has also been suggested that the basal ganglia may have similar speech programming functions.

This type of injury can be caused by trauma, tumors, degenerative diseases, and other neurological disorders, although the most frequent etiology is usually cerebrovascular accident. Brain damage usually occurs in the parietal lobes or adjacent areas, with preservation of learned movement patterns.

Less commonly, apraxia of speech results from damage to other brain areas, such as the cortex premotor (located just anterior to the motor cortex), other areas of the frontal lobe, or the corpus callosum; It can also happen that there is a diffuse affectation linked to degenerative dementias.

Types of apraxia of speech

There are two main types of apraxia of speech: acquired apraxia of speech and childhood apraxia of speech. Let's see what each of them consists of.

acquired apraxia of speech

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 damage to areas of the brain that are involved in speech and results in loss or impairment of speaking skills. It can be the result of a stroke, head injury, tumor, or any other disease that affects the brain.

Also, this type of apraxia of speech may occur with other disorders affecting the nervous systemsuch as: dysarthria, a disorder characterized by difficulty articulating sounds and words, caused by a paralysis or ataxia of the nerve centers that control the organs phonatory; or aphasia, a language condition that consists of the difficulty or inability to communicate through speech, writing or mimicry, due to brain lesions.

childhood apraxia of speech

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

Although the muscles involved in the speech process are not weak, they do not work as they should because there is obvious difficulty in directing or coordinating movements. However, the causes of this disorder are still not fully understood, since studies and tests Neuroimaging techniques have been unable to find evidence of brain damage or differences in brain structure in these children.

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

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characteristic symptoms

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

The person makes trials and errors and then tries to self-correct.

• There is an articulatory inconsistency over repeated productions of the same statement (the person does not manage to articulate the sounds well even if he tries several times).
• There are prosody errors (in stress, intonation and rhythm).
• There are incoherent speech errors (for example, the person says a word correctly but then cannot repeat it).
• There is a distortion in the sounds and difficulties in pronouncing words correctly (due to the inability to position the orofacial muscles correctly).
• The person has difficulty initiating a statement (hesitates when he begins to articulate the first words).

Treatment

The goal of treatment for apraxia of speech is to make the patient able to communicate effectively.; therefore, what the professional pursues is to restore, as far as possible, the patient's speech, that is, to make it functional even if it is not possible to return the person to the levels of communication that existed before the appearance of the disorder.

Currently, there is a consensus that there are five categories of treatment for apraxia of speech: kinematic articulatory; treatment based on rate and/or rhythm; alternative and/or augmentative communication; facilitation and intersystemic reorganization; and other treatments.

Kinematic articulatory treatment focuses on treating articulation problems, focusing on the spatiotemporal aspects of speech production. Regarding the methods based on the rate and/or rhythm, his method is based on treating the alteration that the patients present in the times of speech production, helping them to control the rhythm to, in this way, recover the temporary patterns of speech. speaks.

As to alternative and augmentative communication, are two forms of intervention that seek to improve communication through the use of modalities other than the traditional use of speech. Some activities in this method involve the use of symbols, drawings and communication boards, computer programs, etc.

Finally, in relation to intersystemic facilitation and reorganization techniques, it should be noted that these methods include the use of systems and modalities that are intact in the patient to facilitate the implementation of other modalities and systems that are altered; For example, through the use of gestures or graphic stimuli that facilitate speech, singing familiar melodies, etc.

Bibliographic references:

• R. González Victoriano and L. Toledo Rodríguez, "Apraxia of Speech: Evaluation and Treatment," 2015. [Online]. Available: http://repositorio.uchile.cl/handle/2250/134234
• Ygual-Fernández A, Cervera-mérida JF. Verbal dyspraxia: clinical characteristics and logopedic treatment. Rev Neurol. 2005; 40: 121-26