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Apraxia is a disorder of voluntary muscle movement – where the brain has difficulty transmitting signals to the speech muscles for purposeful movements. It is not related to muscle weakness or a person’s lack of understanding. Apraxia is caused by injury to the brain such as stroke or other trauma. It often seems bewildering to family and caregivers since individuals with apraxia may not be able to say words when thinking or trying to, but words may pop out correctly at other times. For example, a person with apraxia may spontaneously say “I’m fine.” when asked “How are you?” or may shout a word when they stub their toe, yet they have trouble answering questions that require them to think of a response (e.g., “What did you have for lunch?”). In severe cases, speech may be absent.

Often, an individual with apraxia may struggle to say sounds and words in an effortful manner. Other times, they may be able to say over learned words or use rote language (e.g., count numbers or sing the alphabet song), but not use other words. They know what they want to say, however, the sounds may come out jumbled, in the wrong order, or not at all. Difficulties may also occur with non-speech movements of the face, mouth, tongue, lips and jaw.

Speech therapy can support individuals and their families by providing education regarding this disorder and strategies to help speech production. Ongoing intensive therapy is often required to help address baseline motor skills. Music therapy is sometimes quite helpful and can support speech therapy goals.

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Developmental Apraxia of Speech

Children with articulation difficulties who struggle with voluntary or imitative production of speech may present with a developmental apraxia of speech. Errors often become more obvious as speech and language skills develop. There is no weakness in the muscles used for speaking and no obvious neurological cause.

Speech difficulties may differ from child to child. A very young child may not babble as an infant and demonstrate delayed onset of first words. Some children have difficulties saying sounds, syllables or words. They know what they want to say, however, their brain has trouble coordinating the muscle movements to say words correctly.

Speech therapy can help work toward establishing increased control and coordination of speech muscles, to promote speech sound development and improve intelligibility.