Quick Guide To Aphasia Vs Apraxia Of Speech

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!

Table Of Contents

Aphasia vs Apraxia of Speech
Apraxia of Speech Treatment Approaches
Aphasia Treatment Approaches
How To Treat Aphasia and Apraxia At The Same Time
More Resources
References

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.

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*			✓

(Informed by The Apraxia of Speech Rating Scale by Strand et al. 2014; Wambaugh, n.d.)

Apraxia of Speech Treatment Approaches

Click for apraxia of speech handouts and worksheets

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

Click for aphasia worksheets and treatment ideas

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

Receptive Aphasia Treatment Approaches

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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