Aphasia vs. Apraxia: What is the Difference?
Language is one of the most remarkable attributes of human beings, enabling us to communicate thoughts, emotions, and ideas. However, language disorders can impair this ability, leading to various communication challenges.
Aphasia and Apraxia are often confusing disorders due to their overlapping symptoms. This comprehensive article will delve into the intricacies of aphasia vs. apraxia, exploring their differences, causes, symptoms, diagnosis, treatment, and impact on those affected.
What is Aphasia?
Aphasia is a language disorder characterized by difficulties with speaking, understanding written or spoken language, reading, and writing.
People with aphasia may have trouble finding words, speaking in complete sentences, or understanding numbers. Aphasia can take many forms, but some of the most common are Broca's aphasia, which makes it hard to speak, and Wernicke's aphasia, which makes it hard to understand and speak.
Symptoms of Aphasia
Aphasia can cause a various symptoms that vary in severity and presentation depending on the type of aphasia. Some common symptoms include:
Speaking: People with aphasia may have trouble forming sentences, finding words, or speaking fluently. They may pause or interrupt themselves, making communicating their thoughts difficult.
Understanding: People with aphasia may have difficulty understanding spoken or written language. They may need help following conversations, comprehending written text, or responding to questions or instructions.
Writing: People with aphasia may have trouble writing. They may need help writing legibly, conveying their ideas effectively, or correctly using grammar. They may also misspell words or need help organizing their thoughts on paper.
Vocabulary: People with aphasia may have a reduced vocabulary. This can make it hard for them to remember and use common words. They may use vague or indirect language to compensate for their word-finding difficulties.
Numbers: People with aphasia may have difficulty understanding and using numbers. Simple arithmetic, counting, and managing finances can be challenging for those with aphasia.
Causes of Aphasia
Aphasia primarily results from damage to specific areas of the brain responsible for language processing. The most common causes include:
Stroke: Stroke is a leading cause of aphasia. A stroke occurs when a blood clot blocks or a blood vessel ruptures in the brain. This deprives brain cells of oxygen and nutrients and can cause damage to the language centers.
Head Injury: Traumatic Brain Injuries (TBI) resulting from accidents, falls, or other forms of head trauma can lead to aphasia. The severity and type of aphasia can vary based on the nature and extent of the injury. Even seemingly minor head injuries can disrupt language functions.
Brain Tumor: Brain tumors, whether benign or malignant, can exert pressure on areas of the brain responsible for language. The tumor can interfere with language processing as it grows, leading to aphasia symptoms. The effects may vary depending on the tumor's size, location, and growth rate.
Neurological Conditions: Certain neurological conditions, such as Alzheimer's disease or frontotemporal dementia, can cause language difficulties resembling aphasia. These conditions involve progressive degeneration of brain tissue, including language centers, resulting in gradual language impairment.
Brain Infections: Infections that affect the brain, such as encephalitis or meningitis, can cause damage to the brain tissue, including areas responsible for language. This damage can result in aphasia symptoms, which may vary depending on the extent of brain involvement.
Diagnosis of Aphasia
Diagnosing aphasia involves a comprehensive assessment by a speech-language pathologist (SLP) or a neurologist. This assessment may include:
Language Testing: The assessment's core consists of evaluating the individual's language abilities. The evaluation includes assessing their ability to understand spoken and written language and their capacity to express themselves through speech and writing. Specific language tests and tasks are used to gauge the extent and nature of language impairment.
Speech-language pathologists often use standardized aphasia assessment tools to quantify the severity and type of aphasia. These tests help in establishing a baseline and tracking progress during treatment.
Neuroimaging: Neuroimaging techniques such as MRI (Magnetic Resonance Imaging) or CT (Computed Tomography) scans may be conducted to visualize the brain's structure and identify any areas of damage or abnormalities. This imaging helps confirm the neurological basis of the disorder and can provide valuable insights into its underlying cause.
Medical History: Gathering a comprehensive medical history is crucial in diagnosing aphasia. Information about the individual's past medical conditions, recent illnesses, injuries, surgeries, and medications can provide an essential context for understanding aphasia's onset and potential causes.
Behavioral Observation: Observing the individual's communication behaviors in natural contexts can provide valuable insights into their everyday communication disorders. The evaluator may assess their ability to engage in conversations, follow instructions, or effectively convey their thoughts and needs.
What is Apraxia of Speech?
Apraxia is a speech disorder that affects the physical coordination needed for speaking. It is caused by problems in the brain's motor planning and execution centers. Unlike aphasia, which is a language disorder, apraxia does not affect people's ability to understand language.
People with apraxia often have difficulty pronouncing sounds and words, leading to distorted or inconsistent speech. Longer and more complex phrases can be especially difficult for people with apraxia to say. Many people with apraxia are aware of their speech errors but may have difficulty correcting them.
Symptoms of Apraxia
The symptoms of apraxia are characterized by several distinctive features that highlight the motor speech difficulties experienced by affected individuals. These features include:
Difficulty with articulation: One of the symptoms of apraxia is difficulty coordinating the precise movements necessary for speech sounds and articulation, which may result in distorted or imprecise pronunciation of words and sounds.
Inconsistent Errors: Individuals with apraxia tend to produce unpredictable speech errors. This means that the same word may be pronounced correctly in one instance and incorrectly in another, even when the individual is trying to say the same thing.
Difficulty with Longer Phrases: Longer and more complex phrases or sentences pose particular challenges for individuals with apraxia. Maintaining clarity and coherence in extended speech can be especially problematic.
Groping Movements: Some individuals with apraxia may exhibit probing muscle movements or attempts to find the correct articulatory position before producing a sound or word.
Slow and Effortful Speech: Apraxic speech is often slow and requires significant effort. Individuals may struggle to initiate speech or transition between sounds and syllables smoothly.
Awareness of Errors: A notable aspect of apraxia is that individuals are often aware of their speech errors. They may recognize that their pronunciation is incorrect but find correcting the errors in real-time is challenging.
In addition to these general symptoms, people with apraxia may also have difficulty with specific aspects of speech, such as:
Prosody: Prosody refers to the rhythm, stress, and intonation of speech. People with apraxia may have difficulty with prosody, which can make their speech sound unnatural or robotic.
Sequencing: Sequencing refers to the ability to produce sounds and words in the correct order. People with apraxia may have difficulty sequencing, leading to jumbled speech.
Motor planning: Motor planning refers to the ability to plan and coordinate the movements required for speech. People with apraxia may struggle with motor planning, leading to imprecise or inconsistent speech.
Causes of Apraxia
The exact causes of apraxia are not always clear, but it is generally associated with disruptions in the brain's motor control centers responsible for speech. This damage can be caused by a variety of factors, including:
Brain Damage: apraxia of speech often arises from a brain injury that affects the areas responsible for motor planning and execution of speech movements. This damage can result from various factors, including:
Stroke: Ischemic or hemorrhagic strokes can damage specific regions of the brain that play a critical role in speech-motor control.
Head Trauma: Traumatic brain injuries resulting from accidents, falls, or other head injuries can disrupt the neural pathways involved in speech production.
Tumors: Brain tumors, whether benign or malignant, can exert pressure on or invade brain regions essential for speech-motor coordination.
Degenerative Diseases: Some neurodegenerative disorders can lead to apraxia of speech. These conditions involve progressive deterioration of brain structures, including those responsible for motor control. One notable example is Primary Progressive apraxia of Speech (PPAOS), a rare form of apraxia associated with neurodegenerative changes.
Neurodevelopmental Factors: In some instances, apraxia of speech can be present from childhood and is thought to be related to neurodevelopmental factors. These factors can disrupt the normal development of motor speech skills during early childhood.
Idiopathic Apraxia: In some instances, apraxia may appear without an identifiable cause, and it is referred to as idiopathic apraxia. This designation is typically made when no apparent brain damage or neurological condition is present.
Diagnosis of Apraxia
Diagnosing apraxia of speech typically involves a comprehensive evaluation by a speech-language pathologist (SLP). The assessment may include:
Case History and Interviews: The evaluation often begins with a detailed case history and interviews with the individual and their family or caregivers. Gathering information about the individual's medical and developmental record and any relevant family history helps provide context for the assessment.
Oral Mechanism Examination: The SLP assesses the oral structures involved in speech, such as the lips, tongue, and palate, to determine if there are any structural abnormalities or weaknesses that could contribute to speech difficulties.
Articulation and Speech Sound Assessment: The SLP evaluates the individual's ability to produce speech sounds accurately and consistently. This assessment typically includes pronouncing specific sounds, words, and sentences to identify patterns of errors and inconsistencies.
Prosody Assessment: Refers to speech's rhythm, intonation, and stress patterns. The SLP assesses the individual's ability to convey appropriate prosodic features during speech, as apraxia can affect these aspects of communication.
Motor Speech Assessment: This evaluation focuses on motor speech control. The individual is asked to perform oral motor tasks, such as imitating tongue and lip movements or producing specific speech sequences. The SLP observes difficulties in motor planning and execution.
Types of Aphasia and Apraxia
Aphasia and apraxia are not uniform conditions; they encompass various types and severities, each with distinct characteristics. Understanding these different subtypes is essential for tailoring treatment and support to the specific needs of affected individuals.
Types of Aphasia
Broca's Aphasia: Also known as non-fluent aphasia, this type is characterized by difficulties in speech production. Individuals with Broca's aphasia often have limited vocabulary, struggle with grammatical structures, and produce slow and laborious speech.
Wernicke's Aphasia: Wernicke's aphasia, or fluent aphasia, is marked by the production of speech that flows fluently but lacks meaning. Individuals with this type often have difficulties comprehending spoken and written language, and their speech may be filled with nonsensical or inappropriate words.
Global Aphasia is the most severe form affecting language production and comprehension. People with global aphasia may have limited speech output and difficulty understanding language.
Anomic Aphasia: Anomic aphasia primarily involves difficulty finding and retrieving words from memory. Individuals with anomic aphasia often describe objects or concepts using vague language because they struggle to recall specific words.
Conduction Aphasia: Conduction aphasia is characterized by difficulty accurately repeating words or phrases despite relatively preserved language comprehension and production. This difficulty in repetition indicates a disruption in the pathways connecting language centers in the brain.
Transcortical Aphasia: Transcortical aphasias are less common and involve specific language deficits. For example, transcortical motor aphasia results in difficulties initiating speech, while transcortical sensory aphasia affects comprehension but preserves repetition abilities.
Types of Apraxia
There are two main types of apraxia of speech: acquired apraxia of speech and childhood apraxia of speech (CAS).
Acquired apraxia of speech can affect people of all ages, but it is most common in adults. It is caused by damage to the parts of the brain that are involved in speaking. A stroke, head injury, tumor, or other neurological conditions can cause this damage. Acquired apraxia of speech can also occur with other disorders, such as dysarthria and aphasia.
Childhood apraxia of speech is present from birth. It is not the same as a developmental delay in speech, in which a child follows the typical path of speech development but more slowly. The causes of childhood apraxia of speech are not fully understood, but there is evidence that genetic factors may play a role. Childhood apraxia of speech affects more boys than girls.
Age Groups Impacted By Aphasia or Apraxia of Speech
Aphasia and apraxia can affect individuals of all ages, although their prevalence and causes may vary across different age groups. Here's a breakdown of who can be affected by both aphasia and apraxia:
Who is Affected by Aphasia:
Adults and Seniors
Aphasia is most commonly associated with adults and older adults. It is often a result of conditions such as stroke, traumatic brain injury, or neurological diseases that are more prevalent in these age groups. The risk of aphasia increases with age due to the higher incidence of stroke and age-related neurological conditions.
Children
While less common, aphasia can also affect children, especially when they experience brain injuries or developmental disorders that impact language processing. Pediatric aphasia is typically managed differently from adult aphasia and may involve speech-language therapy.
Who is Affected by Apraxia:
Children
Childhood Apraxia of Speech (CAS), also known as developmental apraxia of speech, primarily affects children. It is a neurologically based speech disorder that disrupts the planning and coordination of the movements required for speech. CAS can occur from early childhood, and its exact causes may not always be clear.
Adults
Apraxia of speech can also affect adults, mainly due to brain injuries, strokes, or neurological conditions that disrupt the brain's motor control centers. Acquired apraxia of speech in adults is distinct from CAS in children regarding its causes and manifestations.
Frequently Asked Questions
1. Are aphasia and apraxia curable?
Aphasia and apraxia are not typically considered curable in the traditional sense but treatable. The extent of recovery depends on various factors, including the type and severity of the condition, the underlying cause, and the individual's response to therapy.
Speech-language therapy is a key component of treatment and can significantly improve communication abilities and quality of life for individuals with aphasia or apraxia.
2. How common are aphasia and apraxia of speech?
Aphasia and apraxia are relatively common language disorders. Aphasia, in particular, is estimated to affect approximately 1 in 250 people, with stroke being a leading cause. The prevalence of apraxia of speech is less well-documented, but it can occur in children and adults.
3. What is Augmentative and Alternative Communication (AAC)?
Augmentative and Alternative Communication (AAC) is a diverse set of methods and tools to aid individuals with communication challenges, often due to moderate or severe speech disorders or language impairments, such as apraxia of speech or aphasia.
AAC encompasses low-tech solutions like picture boards and gestures and high-tech devices like speech-generating computers or tablets. It serves as a means for individuals to express themselves, facilitating communication and interaction with others when traditional spoken or written language may be limited or inaccessible.
4. How do I take care of someone with aphasia or apraxia?
Caring for someone with aphasia or apraxia involves patience, understanding, and effective communication strategies. Here are some tips:
Encourage the individual to express themselves at their own pace.
Use clear and concise language and speak slowly and in simple sentences.
Be a good listener, give them time to respond, and show empathy.
Involve them in conversations and activities to maintain social engagement.
Support their participation in speech therapy and rehabilitation programs.
Seek guidance from speech-language pathologists on communication strategies and techniques.
How Can Connected Speech Pathology Help You
Our team of experienced speech pathologists understands that effective communication is not just about articulating words; it's about conveying thoughts, emotions, and ideas with confidence and precision.
We utilize evidence-based techniques to assess and address issues that surface in those living with apraxia and aphasia. Our goal is to empower you with the tools and strategies to communicate effectively in all aspects of life.
At Connected Speech Pathology, we believe everyone deserves the opportunity to express themselves fully and connect with others on a deeper level. Our holistic approach goes beyond traditional therapy sessions; we work collaboratively with clients and their families to create a supportive and nurturing environment for growth.
Conclusion
Aphasia and apraxia are complex language disorders that can significantly impact an individual's communication ability. While they are not typically considered curable, they are treatable conditions.
Early diagnosis, speech therapy, and ongoing support are vital in improving communication outcomes and enhancing the quality of life for those affected by these disorders.
Understanding the differences between aphasia and apraxia and the available treatment options is essential for providing the best possible care and support to individuals and their families.
About the Author
Allison Geller is a speech-language pathologist (SLP) and the owner of Connected Speech Pathology. She obtained her Bachelor’s and Master’s degrees from the University of Florida in Speech-Language Pathology. Allison has practiced speech therapy in a number of settings including telepractice, acute care, outpatient rehabilitation, and private practice. She has worked extensively with individuals across the lifespan including toddlers, preschoolers, school-aged children, and adults. She specializes in the evaluation, diagnosis, and treatment of a variety of communication disorders including receptive/expressive language disorders, articulation disorders, voice disorders, fluency disorders, brain injury, and swallowing disorders.
Allison served as the clinical coordinator of research in aphasia in the Neurological Institute at Columbia University Medical Center in New York. She is on the Board of Directors for the Corporate Speech Pathology Network (CORSPAN), a Lee Silverman Voice Treatment (LSVT) certified clinician, and a proud Family Empowerment Scholarship/Step-Up For Students provider. Allison is passionate about delivering high quality-effective treatment remotely because it’s convenient and easy to access. What sets us apart from other online speech therapy options is—Allison takes great care to hire the very best SLPs from all over the country.
