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Apraxia

Verbal apraxia; Dyspraxia; Speech disorder - apraxia; Childhood apraxia of speech; Apraxia of speech; Acquired apraxia

Apraxia is a disorder of the brain and nervous system in which a person is unable to perform tasks or movements when asked, even though:

• The request or command is understood
• They are willing to perform the task
• The muscles needed to perform the task work properly
• The task may have already been learned

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Causes

Apraxia is caused by damage to the brain. When apraxia develops in a person who was previously able to perform the tasks or abilities, it is called acquired apraxia.

The most common causes of acquired apraxia are:

• Brain tumor
• Condition that causes gradual worsening of the brain and nervous system (neurodegenerative illness)
• Dementia
• Stroke
• Traumatic brain injury
• Hydrocephalus

Apraxia may also be seen at birth. Symptoms appear as the child grows and develops. The cause is unknown.

Apraxia of speech is often present along with another speech disorder called aphasia. Depending on the cause of apraxia, a number of other brain or nervous system problems may be present.

Symptoms

A person with apraxia is unable to put together the correct order of muscle movements. At times, a completely different word or action is used than the one the person intended to speak or make. The person is often aware of the mistake.

Symptoms of apraxia of speech include:

• Distorted, repeated, or left out speech sounds or words. The person has difficulty putting words together in the correct order.
• Struggling to pronounce the right word.
• More difficulty using longer words, either all the time, or sometimes.
• Ability to use short, everyday phrases or sayings (such as "How are you?") without a problem.
• Better writing ability than speaking ability.

Other forms of apraxia include:

• Buccofacial or orofacial apraxia. Inability to carry out movements of the face on demand, such as licking the lips, sticking out the tongue, or whistling.
• Ideational apraxia. Inability to carry out learned, complex tasks in the proper order, such as putting on socks before putting on shoes.
• Ideomotor apraxia. Inability to voluntarily perform a learned task when given the necessary objects. For instance, if given a screwdriver, the person may try to write with it as if it were a pen.
• Limb-kinetic apraxia. Difficulty making precise movements with an arm or leg. It becomes impossible to button a shirt or tie a shoe. In gait apraxia, it becomes impossible for a person to take even a small step. Gait apraxia is commonly seen in normal pressure hydrocephalus.

Exams and Tests

The following tests may be done if the cause of the disorder is not known:

• CT or MRI scans of the brain may help show a tumor, stroke, or other brain injury.
• An electroencephalogram (EEG) may be used to rule out epilepsy as a cause of the apraxia.
• A spinal tap may be done to check for inflammation or an infection that affects the brain.

Standardized language and intellectual tests should be done if apraxia of speech is suspected. Testing for other learning disabilities may also be needed.

Treatment

People with apraxia can benefit from treatment by a health care team. The team should also include family members.

Occupational and speech therapists play an important role in helping both people with apraxia and their caregivers learn ways to deal with the disorder.

During treatment, therapists will focus on:

• Repeating sounds over and over to teach mouth movements
• Slowing down the person's speech
• Teaching different techniques to help with communication

Recognition and treatment of depression is important for people with apraxia.

To help with communication, family and friends should:

• Avoid giving complex directions.
• Use simple phrases to avoid misunderstandings.
• Speak in a normal tone of voice. Speech apraxia is not a hearing problem.
• Do not assume that the person understands.
• Provide communication aids, if possible, depending on the person and condition.

Other tips for daily living include:

• Maintain a relaxed, calm environment.
• Take time to show someone with apraxia how to do a task, and allow enough time for them to do so. Do not ask them to repeat the task if they are clearly struggling with it because it will increase their frustration.
• Suggest other ways to do the same things. For example, buy shoes with a hook and loop closure instead of laces.

If depression or frustration is severe, mental health counseling may help.

Outlook (Prognosis)

Many people with apraxia are no longer able to be independent and may have trouble performing everyday tasks. Ask the health care provider which activities may or may not be safe. Avoid activities that may cause injury and take the proper safety measures.

Possible Complications

Having apraxia may lead to:

• Learning problems
• Low self-esteem
• Social problems

When to Contact a Medical Professional

Contact the provider if someone has difficulty performing everyday tasks or has other symptoms of apraxia after a stroke or brain injury.

Prevention

Reducing your risk of stroke and brain injury may help prevent conditions that lead to apraxia.

References

Basilakos A. Contemporary approaches to the management of post-stroke apraxia of speech. Semin Speech Lang. 2018;39(1):25-36. PMID: 29359303 pubmed.ncbi.nlm.nih.gov/29359303/.

Kirshner HS. Dysarthria and apraxia of speech. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff’s Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 14.

National Institute on Deafness and Other Communication Disorders website. Apraxia of speech. www.nidcd.nih.gov/health/apraxia-speech. Updated October 31, 2017. Accessed July 29, 2022.

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Review Date: 5/2/2022  

Reviewed By: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist and Assistant Professor of Clinical Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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