Other Speech & Language Disorders

Apraxia of Speech


Apraxia (also referred to as apraxia of speech, verbal apraxia, or dyspraxia) is a motor speech disorder caused by damage to the parts of the nervous system related to speaking. It is characterized by problems sequencing the sounds in syllables and words and varies in severity depending on the nature of the nervous system damage. People with apraxia know what words they want to say, but their brains have difficulty coordinating the muscle movements necessary to say those words and they may say something completely different, even nonsensical. For example, a person may try to say "kitchen", but it may come out "bickem". The person will recognize the error and try again, sometimes getting it right, but sometimes saying something else entirely. This can become quite frustrating for the person.

Characteristics of Apraxia include:

  • Difficulty imitating speech sounds
  • Possible difficulty imitating non-speech movements, such as sticking out their tongue (oral apraxia)
  • Groping for sounds
  • In severe cases, an inability to produce sound at all
  • Inconsistent errors
  • Slow rate of speech
  • Somewhat preserved ability to produce "automatic speech", such as greetings like "How are you?"
  • Can occur in conjunction with dysarthria (muscle weakness affecting speech production) or aphasia (language difficulties related to neurological damage)

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senior woman holding her head

After a stroke or other brain injury, the muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all. The resulting speech condition is called dysarthria. The type and severity of dysarthria depends on which area of the nervous system is affected.


A person with dysarthria may experience any of the following symptoms, depending on the extent and location of damage to the nervous system:

  • Slurred speech
  • Speaking softly or barely able to whisper
  • Slow rate of speech
  • Rapid rate of speech with a "mumbling" quality
  • Limited tongue, lip, and jaw movement
  • Abnormal intonation (rhythm) when speaking
  • Changes in vocal quality ("nasal" speech or sounding "stuffy")
  • Hoarseness
  • Breathiness
  • Drooling or poor control of saliva
  • Chewing and swallowing difficulty


Dysarthria is caused by many different conditions that involve the nervous system, including: Stroke, Brain Injury, Tumors, Cerebral Palsy, Parkinson's Disease, Lou Gehrig's Disease [ALS], Huntington's Disease, 
Multiple Sclerosis.
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Aphasia is a disorder that results from damage to language centers of the brain. For almost all right-handers and for about 1/2 of left-handers, damage to the left side of the brain causes aphasia. As a result, individuals who were previously able to communicate through speaking, listening, reading and writing become more limited in their ability to do so. The most common cause of aphasia is stroke, but gunshot wounds, blows to the head, other traumatic brain injury, brain tumor, and other sources of brain damage can also cause aphasia.

Some people with aphasia have problems primarily with expressive language (what is said) while others have their major problems with receptive language (what is understood). In still other cases, both expressive language and receptive language are obviously impaired. Language is affected not only in its oral form of talking and understanding but also in its written form of reading and writing . Typically, reading and writing are more impaired than oral communication. The nature of the problems varies from person to person depending on many factors but most importantly on the amount and location of the damage to the brain. Amount and location of the damage, along with other factors, e.g., age, educational level, and health status, also affect the severity of the problems. Persons with severe aphasia may understand almost nothing of what is said to them and say little or nothing. At best, their oral communication may be only approximations of "yes" and "no" and maybe common social phrases like "hi" and "thanks." Persons with mild aphasia may be able to carry on normal conversations in many communication settings. They may have trouble understanding language only when it is long or complex, or they may have some trouble finding the words they need to express an idea or to explain themselves, orally or in written form. Word finding problems (anomia) are common in people with aphasia and is like the common experience of having a word "on the tip of our tongues" but not being able to remember it. The person may forget the word comb even though he or she can show you how to use it.

There are also degrees of aphasia between mild and severe. A person may speak only in single words (e.g., names of objects) or in short, fragmented phrases. Smaller words of speech (e.g., the , of , and ), may be omitted, making the message sound like a telegram. Words may be put in the wrong order. Incorrect grammar may be used. Sounds and/or words may be switched. A bed may be called a table or a dishwasher a wish dasher. Or, the person with aphasia may make up a word. In some cases, nonsense (or real) words are strung together quite fluently, but make no sense to the listener.

It usually requires extra effort for the person with aphasia to understand spoken messages, as if he or she is trying to comprehend a foreign language. The person may need extra time to process and understand what is being said. It may be especially hard to follow very fast speech like that heard on radio or television news. He or she may misinterpret subtleties of language, e.g., taking the literal meaning for a figure of speech like He kicked the bucket. Difficulty with one or more of these skills may lead to communication breakdowns and frustrating communication for both the person with aphasia and his or her listeners. Other conditions may result from stroke, either by themselves or in addition to aphasia. These include dysarthria, apraxia, and dysphagia.
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