Apraxia of Speech/Motor Speech Disorder in Adults/Geriatrics

Apraxia of speech is a motor-speech programming disorder resulting in difficulty executing and/or coordinating (sequencing) the oral- motor movement necessary to produce and combine speech sounds (phonemes) to form syllables, words, phrases and sentences on voluntary (rather than only reflexive) control. Many adults and geriatrics are able to hear words, and are able to understand what they mean, but they cannot change what they hear into the fine-motor skill of combining consonants and vowels to form words. This difficulty in combining consonants and vowels into words upon direct imitation is called apraxia of speech. Many adults and geriatrics do have “pop-outs” which are real words and phrases they are able to say or have said in the past, but are either never heard again, or cannot be imitated when asked to do so. Here at the STC, we provide a systematic program that helps apraxic adults and geriatrics be able to combine simple to complex consonants and vowels into functional vocabulary.Family and friends are trained to script best words approximations towards functional vocabulary and language development. This is done through drill, conversation, and play, with cues, prompts and support. Oral-motor weakness or dysarthria may co-exist but must not be a primary concern.

Early Signs and Symptoms

• Limited or little babbling as an infant (void of many consonants). First words may not appear at all, pointing and “grunting” may be all that is heard.
• The adult or geriatric is able to open and close mouth, lick lips, protrude, react and lateralize tongue while eating, but may not be able to when directed to do so.
• First word approximations occurring beyond age 18 months, without developing into understandable simple vocabulary words by age two.
• Continuous grunting and pointing beyond age two.
• Lack a significant consonant repertoire: adult or geriatric may only use /b, m, p, t, d, h/
• All phonemes (consonants and vowels) may be imitated well in isolation, but any attempts to combine phonemes are unsuccessful.
• Prosody is unusual, there is equal stress and sometimes monotone quality.
• Speech may change or disintegrate with many repetitions.
• Words may be simplified by deleting consonants or vowels, and/or replacing difficult phonemes (consonants and vowels) with easier ones.
• Single words may be articulated well, but attempts at further sentence length become unintelligible.
• Receptive language (comprehension) appears to be better than attempts at expressive language (verbal output).
• One syllable or word is favored and used to convey all or many words beyond age two.
• The adult or geriatric speaks mostly in vowels.
• Verbal perseveration: getting “stuck” on a previously uttered word, or bringing oral motor elements from a previous word into the next word uttered.
• Oral groping may occurring when attempting oral motor movements or consonant/vowel production.
• Struggle behavior may occur when attempting to imitate or speak (with dysfluency or stuttering).
• Deletions or replacements of consonants, vowels or syllables may occur at the end of a word, phrase or connected word levels.
• Vowel distortions or replacements occur which are not due to oral motor weakness.
• The ability to blurt out clear whole words, phrases or sentences may occur though there is difficulty imitating these same words “on command” or upon imitation.
• Difficulty with maintaining clarity with extended word length or complexity.
• Phonological processes are employed to simplify motor speech output.
• Late talking with above characteristics or errors may be present.
• Other fine motor challenges may be present.
• Echolalic utterances (the automatic repetition of words, phrases or sentences often without comprehension) might be perfectly articulated but novel attempts at words or combinations might be more effortful.

Information courtesy of the Kaufman Children’s Center.