Apraxia of speech

Also called Acquired apraxia of speech, Verbal apraxia, AOS

The person knows the word and the muscles are strong; what's lost is the plan for moving them, so the same word comes out differently every time.

What it is

Apraxia of speech is a difficulty planning and sequencing the movements that produce speech. The muscles aren't weak (that's dysarthria) and the language is intact (that's aphasia); the fault is in the motor programme between the two. In adults it's almost always acquired, from a stroke or brain injury, and it usually arrives alongside some aphasia.

The tell-tale sign is inconsistency. Ask for the same word three times and you get three different attempts, with visible groping for the position. Automatic speech, such as counting or swearing, often comes out perfectly, which confuses everyone and proves the point: the word is there.

Who it can help

This entry is for adults with acquired apraxia and the people around them. Children who grow up with the same planning difficulty have their own entry at childhood apraxia of speech, because the therapy and the outlook differ.

It's not the right explanation for consistently slurred speech, or for speech that's clear but empty of the right words.

How it works

Speech is one of the fastest movement sequences the body makes, and apraxia disrupts the sequencing. Longer words are harder than short ones; consonant clusters are harder than single sounds; a word said on demand is harder than the same word said in a familiar phrase. Severity ranges from occasional stumbles to almost no volitional speech at all.

Therapy is motor practice: many repetitions of target words with the therapist modelling the mouth shape, slowing the sequence, and building it back up. Some programmes tap a rhythm or use melody, because the singing route into speech is often less damaged than the speaking route. Progress is real but measured in weeks and months.

While speech is unreliable, AAC has to be in place from the start, not offered once therapy has "failed". Text works well for people who can spell; symbol boards work when spelling is affected by the aphasia alongside.

Getting started

As a partner, give time and don't supply the word until asked. Keep a pad and pen close; writing or drawing often bypasses the block. Notice which phrases come out automatically and use them as anchors.

Ask the speech and language therapist for a home practice list of ten high-value words and phrases (names, "toilet", "pain", "phone") and practise them for five minutes several times a day rather than one long session. Little and often is how motor learning happens.

Set up a text-to-speech app or a low-tech board for the days when nothing will come. Having it doesn't discourage speech; it takes the panic out of trying.

Where to get help

Speech and language therapy via the stroke or neurology team, or the GP. The RCSLT explains the profession and what to expect. The Stroke Association and Headway both cover apraxia within their communication guidance and run local groups where you'll meet people who've been where you are.