Motor Speech Disorders 113apraxia, sometimes called motor apraxia, execution of the movement is defective. Table 6-1 shows
the three levels of motor speech programming and apraxias of speech.
Clinical Patterns of Apraxia of Speech
Patients with apraxia of speech complicate the speech act. In this sense, apraxia of speech
resembles the effortful compensatory be hav iors of stuttering. One feature of apraxia of speech is
the dichotomy between voluntary and involuntary speech. When utterances are automatic and
overlearned, they can sometimes be said easily and normally. By contrast, propositional, volun-
tary, thoughtful, and purposeful utterances result in verbal impotence. Speech programmed and
executed with little forethought is called automatic speech.
Because repeated speech is propositional, voluntary, thoughtful, and purposeful, impaired
repetition is often a hallmark of apraxia of speech and can be a diagnostic feature of the disorder
(Tanner & Culbertson, 1999b). Patients also tend to perseverate on apraxic utterances and while
struggling to create the proper programming. They may also insert the schwa vowel, another
similarity between stuttering and apraxia of speech. Because apraxia of speech is a nonsymbolic
neurogenic communication disorder, patients are aware of their errors but are often unable to self-
correct, particularly when the disorder is severe. Programming the initial aspects of an utterance
usually involves more error than subsequent aspects of the speech act.
Treatment of Apraxia of Speech
In aphasia, the goals of therapy are to relearn and deblock language. Aspects of expressive and
receptive grammar, syntax, phonology, and semantics are targeted for treatment. Although motor
speech programming deficits are frequently a part of expressive aphasia, the treatment of apraxia
of speech involves motor speech, not language. As a practical clinical matter, the goals, objectives,
and treatment methods for aphasia and apraxia of speech may overlap; however, voluntary motor
speech control is the goal of apraxia of speech therapy. Treating apraxia of speech in patients who
also have significant aphasia is challenging. Patients with aphasia have difficulty comprehending
instructions and have expressive language deficits, creating communication barriers that interfere
with learning. Concomitant disorders such as perseveration, echolalia, and emotional lability also
interfere with apraxia of speech therapies.
According to the National Institute on Deafness and Other Communication Disorders (2015),
no single approach to the treatment of apraxia of speech has been proven to be the most effective.
Duffy (1995) considers drill an impor tant aspect of apraxia of speech treatment: “Virtually every
specific behavioral treatment approach for AOS [apraxia of speech] emphasizes drill” (p. 421).