Language is the main system we humans use to communicate. Whether it is to express thoughts, ideas, or emotions, we all use language. However, communication disorders like aphasia and apraxia can impair this ability, leading to major challenges.
Aphasia affects approximately 2–4 million people in the United States, and about 100,000–180,000 more develop it each year, while 75% of children with apraxia are misdiagnosed. Clearly, they often get confused together due to their similar spelling and overlapping symptoms—so what are their differences?
The following will delve into what sets aphasia and apraxia apart. Understanding these differences will assist you if you feel like a family member might have either condition or if you are currently studying for an online Master's in Speech Pathology and wish to provide proper treatment to patients in the future.
What Is Aphasia?
Aphasia is generally characterized as a language disorder in which brain areas responsible for language processing are damaged. Overall, this may make understanding words, finding words to express a thought or idea, comprehending grammatical sentences, and reading or writing words of sentences difficult.
The disorder can manifest itself in different ways depending on the type of aphasia. The five most common types include:
Broca's Aphasia (Non-fluent Aphasia)
Broca's aphasia, also called expressive aphasia, is where someone may find it difficult to speak, but can understand others. People with Broca's aphasia may only be able to express single words or use short sentences.
Wernicke's Aphasia (Fluent Aphasia)
Also referred to as receptive aphasia, this form of aphasia is where someone can speak fluently, but what they say appears to be incoherent and does not make sense. Obviously, this leads to difficulties in understanding for both parties.
Anomic Aphasia
Usually designated as a milder form of aphasia, anomic aphasia consists of relatively well-preserved speech and comprehension but difficulties in finding words or naming items.
Primary Progressive Aphasia (PPA)
As per its name, PPA is a gradual degeneration and loss of the ability to read, write, speak, or understand other people's words. This can happen slowly on parts of the brain that control speech and language, and symptoms can vary depending on the area affected.
Global Aphasia
This is the most severe form of aphasia. Someone with global aphasia can only produce very few recognizable words and can understand very little to none of the spoken language. Yet at the same time, cognitive function and intellectual capacities unrelated to language or speech can be perfectly preserved.
What Causes Aphasia?
Stroke, brain tumors, brain infections, dementia, Alzheimer's disease, or any physical injury to the head that has caused damage to language-processing areas of the brain can bring about aphasia.
It must be noted that aphasia does not impact intelligence and is not an intellectual disorder. Misunderstandings and the sheer lack of information concerning the disorder have led people to draw false conclusions. Nevertheless, communication can be quite frustrating for people with aphasia, whether at home or work, which can lead to loneliness and isolation.
Diagnosis, Treatment, and Living with Aphasia
Apahia is usually diagnosed through magnetic resonance imaging (MRI) or a computed tomography scan (CT), which can assist in identifying brain damage. Additional diagnosis can also be made by a speech-language pathologist who completes a comprehensive language assessment to confirm whether aphasia is present. Treatments for the disorder can depend on severity, symptoms, age, and general health. Some methods may include speech-language therapy, nonverbal communication therapies, such as through computers or pictures, or group therapy for patients and families.
Frustration, sadness, loneliness, and isolation are understandably common emotional effects for those with aphasia. While some people can recover from the condition without treatment, for most people, some degree of it remains for the rest of their lives. It is important to maximize inclusion for those with aphasia, and family members must learn how to use the best ways to communicate with a loved one. Some tips may include:
- Ensure that the individual can hear and is paying attention to you.
- Use gestures while talking.
- Use drawings or visual stimuli when appropriate.
- Make your messages short and simple, and speak slowly but naturally.
- Repeat keywords or make clarifications if needed.
- Ask closed-ended questions with fixed answers such as 'yes/no.'
- Avoid attempting to correct what they have said.
- Give them the time and space to respond and express themselves.
What Is Apraxia?
Like aphasia, apraxia (apraxia of speech (AOS) in full) affects an individual's communication abilities. However, what sets it apart is that apraxia is a motor speech disorder. While it may not seem as such, speaking actually requires many fine motor skills from the brain to the lips, jaw, and tongue.
Apraxia is an inability to produce intelligible speech, which leads individuals to struggle with, for example, consonant clusters, rhythm, stress, and difficulties in prosody. The disorder, therefore, is a consequence of damage to areas of the brain involved in speech processing. There are two main types of AOS based on age:
Acquired AOS
This form of apraxia can affect anyone but is primarily seen among adults. Individuals with acquired AOS may speak especially slowly and struggle to find the correct words or sounds. They may also try to find substitutes or distort sounds to compensate for this difficulty, which leads to mispronunciations or unintelligible speech.
Childhood AOS
Also known as developmental apraxia of speech, this form of the disorder is present from birth and is usually diagnosed during childhood. A child with AOS may say a word differently each time they say it and can find difficulties in starting or transitioning between sounds or words, giving a disconnected or 'choppy' sound. Childhood AOS remains not well understood, though studies have found genetics may play a role in the disorder.
What Causes Apraxia?
Apraxia is also caused by direct physical damage to the brain. In acquired AOS, the most common causes include stroke, a traumatic brain injury (TBI), tumor, surgical trauma (e.g. any surgeries on the brain), or progressive disease/degenerative condition (e.g. progressive supranuclear palsy).
On the other hand, as mentioned before, childhood AOS can be hereditary and run in families. But it also can be a symptom of a larger, more complex disorder such as autism, epilepsy, cerebral palsy, galactosemia, or a neuromuscular disorder. Nevertheless, other causes of childhood AOS remain elusive, so further research is still required.
Diagnosis, Treatment, and Living with Apraxia
As no single symptom can determine the presence of apraxia, speech-language pathologists usually look at multiple or a common group of symptoms. They will also look at the movements of the mouth, lips, and tongue and the sound of speech in single words, sentences, and conversation. Currently, there is no exact cure for apraxia, though, like aphasia, speech therapy can be an effective way to build up communication skills and support quality of life for apraxia patients. Other treatment options also include melodic intonation therapy (MIT), which uses music to assist in speech; verbal motor production treatment (VMPT), which focuses on improving muscle memory for speech sounds; and so on.
Apraxia can be a challenging condition to live with, so patients must stick with their treatment plan and receive much-needed support from family and friends. Some ways you can help someone or a loved one with apraxia include:
- Encourage practicing speech exercises daily.
- Be patient with communication.
- Make speech exercise fun (e.g. doing it while on a walk, while cooking together, etc.).
- Make sure you are speaking clearly as well.
- Ensure there is a constant relationship with a speech therapist.
Summary
Both aphasia and apraxia affect an individual's ability to use language and communicate with others. An easy way to avoid confusion between the two is to think of aphasia as a disorder relating to language retrieval and recognition and apraxia as related to dysfunction in fine motor skills involving speaking. For more information about aphasia, you can always visit The National Aphasia Association; and for apraxia, the Apraxia Foundation or Apraxia Kids.
