What does it mean to have apraxia?
Typically aphasia and apraxia co-occur, but it can be the case that the apraxia is more severe than the aphasia, so that the person can write in sentences, read relatively well, and understand relatively well. However, apraxia affects the speech output so that there is groping, incorrect sounds, and problems with segmenting syllables. These all affect the intelligibility of the person’s speech, making talking very difficult even though they know what they want to say and don’t have any problems “finding the words”. To skip to the intensive program, click here.
There are different types of apraxia, but all forms have to do with movement. In general, there are problems with voluntary, but not automatic movements. For example, the person with apraxia may suddenly shout “look out!” when a driver makes a wrong turn, but be unable to repeat that phrase when asked to do so. 
When you have damaged a certain part of your brain, you may get apraxia. There is a part of your brain that helps you plan to do something, a part that holds the motor sequencing to do it (pre-motor cortex), and a part that then tells your muscles to carry out that command (motor cortex). Damage to the pre-motor cortex results in problems remembering how to make your muscles do what you want.
Oral apraxia—in oral apraxia, your mouth will not move the way your brain is telling it to move. If I tell you to blow me a kiss, your brain may be trying to make you blow a kiss by puckering your lips. However, your lips may be doing something else, such as pulling back to smile. You may or may not be able to feel that you are making the incorrect movement. If I give you a mirror to see what you are actually doing, you may be surprised to see that your mouth is “groping”. This means that it is making different movements, trying to do what your brain is telling it to do. The connections from your brain to your mouth have been changed. You may start with a smile, then open your jaw, then finally get your lips to pucker. Now, if I didn’t tell you to do it, but your spouse make a kiss-face to you, you may make one in return and be able to do it correctly. This is because your brain is doing it automatically, it doesn’t have to try to remember how to do it.
Verbal apraxia—same problems as in oral apraxia, but it affects your speech. I may ask you to say “we”, and you say “way” or “zoo”, or “ah”. Your brain is telling you say something, but the connections to make you speak it are changed. There are several factors that go in to speaking a word–you need to use your lips, tongue, jaw, teeth, and vocal cords. These must all be coordinated together to produce a sound. For example, to say “ahh”, you must take a breath, turn your voice on, drop your jaw open, and lay your tongue flat or pull it back in your mouth. You may have more than one type of apraxia at a time, depending on how large an area of your brain was affected by the stroke.
Intensive Apraxia Therapy
The key to overcoming apraxia is repetition, repetition, repetition. The severity of the apraxia dictates the length of the treatment. For example, if you cannot make a sound yet, then we need to start with a different treatment than if you can already produce vowel sounds, which in turns takes a longer time. We develop a program just for you based upon your current strengths that incorporates drill, technology, tactile and visual feedback, and hours of practice in natural situations. Our programs are based on research evidence that supports a top-down approach to help generalize to different sounds and situations. Typically, the day will consist of 4 hours of therapy 5 days per week for a number of weeks. The majority of the sessions will be in individual treatment with some group sessions to practice speaking in front of peers.
The cost for this program is dependent upon the package, which is similar to the aphasia packages. The hourly cost is $120 with housing included and $100 without housing. Assessment, homework, lunch, and home programs are included in this cost. Please call 727-823-2529 and speak with Dr. Bartels-Tobin for more details.
