What is the difference between aphasia and apraxia of speech? And if your speech therapy patient has both, which do you treat first?
Read this article for:
- An aphasia vs apraxia of speech checklist
- Evidence-based treatments
- Which to treat first
Let’s get started!
Aphasia vs Apraxia of Speech
Acquired apraxia of speech is a motor speech disorder caused by damage to the parts of the brain that coordinate speech movements. A person with apraxia has trouble coordinating what they want to say clearly and consistently (Duffy, 2013).
Aphasia is a language disorder caused by damage to the parts of the brain that control the ability to understand and express language, including reading and writing.
Apraxia of Speech vs Aphasia Checklist
Below is a checklist to make telling the difference between apraxia and aphasia quick and easy. Feel free to copy, paste, and print it out to use with your patients. Or download the free Differential Diagnosis PDF.
| Yes/No | Characteristic | Apraxia | Aphasia | Rule out Apraxia |
|---|---|---|---|---|
| Articulatory deficits | ✓ | – | ||
| Prosodic deficits | ✓ | – | ||
| Articulatory groping | ✓ | – | ||
| Slow overall speech rate | ✓ | – | ||
| Sound distortions | ✓ | – | ||
| Inaccurate speech AMRs | ✓ | – | ||
| Syllable segmentation within words > 1 syllable | ✓ | – | ||
| Syllable segmentation across words in phrases/sentences | ✓ | – | ||
| Lengthened intersegment durations | ✓ | – | ||
| Lengthened vowel and/or consonant segments | ✓ | – | ||
| Language processing deficits | – | ✓ | ||
| Reading and/or writing abilities affected | – | ✓ | ||
| Sound/syllable repetitions | ✓ | ✓ | ||
| Sound prolongations | ✓ | ✓ | ||
| Fast or normal speech rate | ✓ | |||
| No prosodic errors | ✓ |
Apraxia of Speech Treatment Approaches
Apraxia of speech treatment improves intelligibility by helping patients better coordinate their speech.
Apraxia treatment does this by:
- Using the principles of motor learning
- Using sensory cueing
- Using melody, rhythm, and/or stress
Below are evidence-based apraxia of speech treatment approaches.
Read How To Treat Apraxia of Speech for more on each treatment.
Principles of Motor Learning Apraxia Treatments
- Principles of Motor Learning
- Multiple Input Phoneme Therapy (MIPT)
- Sound Production Treatment for Apraxia
- Speech Motor Learning Treatment Approach (SML)
Sensory Cueing Apraxia Treatments
- Integral Stimulation (Rosenbek’s 8-Step Continuum)
- PROMPT© (Prompts for Restructuring Oral Muscular Phonetic Targets)
- Script Training
Rate and Rhythm Control Apraxia Treatments
- Contractive Stress
- Metronomic Pacing (Rhythmic Pacing Strategies)
- Metrical Pacing
- Melodic Intonation Therapy (MIT)
- Pacing Board
How Long Does Apraxia Treatment Take?
A common struggle with apraxia treatment is that it can take so long that you might wonder if you’re making a difference.
The truth is that apraxia treatment can take weeks, months, or even longer. So the key is to remain patient and persistent.
Since every patient with apraxia of speech is different, treatment lengths vary. In general, the more severe the apraxia, the longer the treatment will take.
Patients with strong motivation, stimulability, and carryover of strategies are more likely to succeed in speech therapy. Keep them engaged during treatment by discussing goals for their speech. Like ordering for themselves at a restaurant or having a conversation with their grandkids.
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Aphasia Treatment Approaches
Your aphasia treatment will focus on improving the underlying language deficits.
Below are evidence-based aphasia treatment approaches. Click on the links to learn how to do each.
Expressive Aphasia Treatment Approaches
- Naming Therapy
- Constraint-Induced Language Therapy
- Semantic Feature Analysis
- Phonological Component Analysis
- Verb Network Strengthening Treatment
- Melodic Intonation Therapy
Receptive Aphasia Treatment Approaches
- Augmented Input
- Supported Conversation for Adults with Aphasia (SCA)
- Picture matching and auditory comprehension
How To Treat Aphasia and Apraxia At The Same Time
Apraxia of speech often co-occurs with aphasia, which can make treatment tricky.
To decide which to treat and in what order, ask yourself: “What is negatively impacting my patient’s communication the most? Language or motor speech?”
Once you have your answer, start treatment there.
Here are some example scenarios:
Focus on Aphasia
- A patient with Broca’s aphasia has severely limited verbal output to mainly nouns
- They also have mild apraxia of speech with imprecise articulatory errors. Their apraxia only mildly affects their intelligibility
- You decide that language is impacting their communication the most, so you focus therapy on increasing verbal expression abilities
Focus on Apraxia of Speech
- A patient with moderate apraxia of speech has speech intelligibility at about 50% in conversation
- They also have mild expressive aphasia that affects their writing at the sentence level, plus mild anomia
- You decide that motor speech is impacting their communication the most
- You start with motor and articulation treatment. Later, you work on writing
More Resources
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References
- American Speech-Language-Hearing Association. (n.d.). Acquired Apraxia of Speech. (Practice Portal). Retrieved March 18, 2024 from www.asha.org/practice-portal/clinical-topics/acquired-apraxia-of-speech/.
- Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
- Duffy, J. R. (2020). Motor speech disorders: Substrates, differential diagnosis, and management (4th ed.). Elsevier.
- Strand, E. A., Duffy, J. R., Clark, H. M., & Josephs, K. (2014). The Apraxia of Speech Rating Scale: a tool for diagnosis and description of apraxia of speech. Journal of communication disorders, 51, 43–50. https://doi.org/10.1016/j.jcomdis.2014.06.008
- Wambaugh, J. (n.d.) Treatment of Acquired Apraxia of Speech: Therapeutic Approaches and Practice Guidelines. Medbridge. https://www.medbridge.com/course-catalog/details/treatment-of-acquired-apraxia-of-speech-therapeutic-approaches-and-practice-guidelines
