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Research Reveals
...Marked improvement for children treated in a structured home program of private speech therapy
To schedule, call Ela Britchkow today at
215-322-6781
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Locations Served | Accent Reduction | Speech Therapy in Schools
| Children | Autism | Orofacial Myology
Apraxia
Ela Britchkow
Apraxia is a speech disorder that interferes with one’s ability to correctly pronounce sounds, syllables and words. The person cannot consistently position the articulators (face, tongue, lips, jaw) for the production of speech sounds and for sequencing those sounds into syllables or words. There is nothing wrong with the muscles themselves. The person does not have difficulty with spontaneous nonspeech sound such as coughing, chewing or swallowing. He/she is able to lick their lips if there is food on them, but if you say “lick your lips”, they may not be able to do it on command. The area of the brain that tells the muscles how to move and what to do to make a particular sound or series of sounds is damaged or not fully developed. The speech sound errors in people with apraxia are inconsistent. Each time they say a word, they say it differently.
Developmental Apraxia
Developmental apraxia of speech is a disorder that occurs in children and is present from birth. When children do not develop speech normally, are unable to produce consonant sounds, and have generalized incoordination, they may be apraxic. The child has difficulty with the organization of muscle movements specifically for the production of speech. However, muscle tone which affects strength and range of the articulators (i.e. speech muscles) is normal. Sounds may be produced correctly in isolation, but as the sequence of sounds grows, the organization of muscle movements becomes more difficult and intelligibility decreases. It is difficult to diagnose because frequently children have an expressive language impairment which can delay the child’s ability to gain voluntary motor control over their speech muscles.
Signs of Developmental Apraxia in Young Children:
- The child does not babble as an infant
- The child will produce words after some delay, but these words are missing sounds.
- The child produces only a few consonant sounds.
- The child has difficulty in combing sounds.
- The child replaces difficult sounds with easier ones or by deleting difficult sounds.
- Sometimes the child may move the muscles used for speech without making sounds.
- The child may have feeding problems.
Signs of Developmental Apraxia in Older Children:
- The child makes inconsistent sound errors that are not the result of immaturity.
- The child has difficulty imitating speech.
- The child may appear to be groping when trying to produce sounds.
- The child may have difficulty in coordinating lips, tongue, and jaw for purposeful movement.
- The child has more difficulty saying longer phrases than shorter ones.
- The child can understand language much better than he/she can produce it.
Ela Britchkow, speech-language pathologist, examines the child’s speech mechanism
( tongue, teeth, lips, hard and soft palate)for purposeful movement by having the client imitate non-speech actions (moving the tongue from side to side to side, smiling, puckering the lips, etc.). It is also important to evaluate the coordination and sequencing of muscle movements for speaking by having the child repeat strings of sounds as fast as possible. The coordination of breathing with speaking, another skill that requires planning and sequencing of muscle movements is evaluated. Speech articulation or how the child produces sounds in words is also evaluated in single words as well as in conversation.
There are several treatment programs for developmental apraxia. Traditional articulation therapy techniques are modified, focusing on improving the planning, sequencing and coordination of motor movements for speech production. For children with limited expressive language, the development of a core vocabulary and highly motivating subjects will improve speech. Therapy usually focuses on sound combinations and movement patterns rather than isolated sounds. A child with apraxia may be able to produce a sound by itself, but not in a word (especially not in a 2-3 syllable word). Children also benefit from pairing speech with other rhythmic motor activities like clapping or marching. When appropriate, the child is taught exercises that strengthen the muscles of the lips, jaw and tongue as well as those that improve the coordination of the speech mechanism. The client and his family are provided with home assignments to accelerate progress and to facilitate carryover of newly learned strategies taught during the speech therapy session.
Acquired Apraxia
Apraxia that happens as a result of an incident causing brain damage is said to be “acquired”. This can result from stroke, head injury, brain tumors, toxins, or infections. It is characterized by problems with sequencing the sounds in syllable 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. This can become quite frustrating for the person.
Characteristics of acquired apraxia include difficulty imitating speech sounds. Possible difficulty imitating no-speech movements, such as sticking out the tongue, groping for sounds and in severe cases, an inability to produce sound at all, inconsistent errors, slow rate of speech, an ability to produce automatic speech: such as “thank you” or “how are you?” Aparaxia can also occur in conjunction with dysarthria (muscle weakness affecting speech production) or aphasia (language difficulties related to neurological damage).
Treatment approaches for apraxia of speech vary, depending on the severity of the impairment. The muscles of speech often need to be “retrained” to produce sounds correctly and sequence sounds into words. This occurs through exercise designed to allow the person to repeat sounds over and over and practice correct mouth movements for sounds. The person with apraxia may need to slow their speech rate or work on “pacing” their speech so that they can produce all of the sounds necessary for their message. In addition to many other techniques that are used, tapping out the rhythm of speech helps some speakers to speak more clearly. People with mild apraxia learn strategies to help them produce the longer words that give them trouble.
Tyler’s Story
I started working with Tyler when he was15 months old. He was a very smart little boy receiving care from his parents and grandparents and was able to make his needs and wants known with gestures, acting out and facial expressions so that he usually was not frustrated. All the other professionals working with him wanted him to learn to use sign language or use augmentative communication such as a picture book or communication board right away. For some children, this is the best route to go. These methods were easier for him to use and may have discouraged him from using speech. This was illustrated when his special instructor taught him to sign “more”. Although he had learned to say it, it was easier for him to sign it, so he insisted on signing. It was my professional judgement that in Tyler's case sign language and communication boards were to be discontinued in favor of promotion normal oral speech communication. His family had to work harder on insisting that he say the word in addition to the sign, before giving him what he wanted. Sometimes, using an action with a word helps the child to produce a word, but professional judgment needs to be used for the most effective results. After almost a year of working on eliciting words from him and intensive oral motor exercises and stimulation, he finally said his first word, “ball”. Once he started using this one word, he was encouraged to use it more frequently and he gradually produced other words to the joy of his parents and grandparents. At age 4, he is producing long sentences and enjoys having interesting discussions about everything. Although his speech sounds still need work, he is able to communicate verbally and effectively.
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