Apraxia
vs. Aphasia
By Dave Valiulis
My
name is David, and this is not how I sounded 4 years ago.
For
no apparent reason, in 2008, a clot reached my brain, giving me a stroke. As a
result...
My
right side didn’t work and I couldn’t speak at all. Back then, I figured this
wasn’t permanent, that soon I would snap out of it. I was right and also wrong.
I can walk again and I can move my right hand again. And I can even talk again
– sort of.
Back in ‘08, I had the following 3 speech conditions:
·
I was unable to say words clearly or loudly enough. This is
called dysarthria.
·
On top of my dysarthria, I had expressive aphasia -- knowing what you want to say but you can’t
think of the words to say it.
·
On top of my aphasia,
I also had apraxia of speech -- not being able to remember
how to make your mouth say the words you want to say.
My dysarthria lasted about 6 months. My aphasia
lasted about 2 years. And my apraxia is 4 years and counting.
I
have often wondered about which is worse – having aphasia or having apraxia.
Certainly,
my aphasia was worse in the
beginning because it prevented me from remembering the words for a thought. Aphasia
also made me confuse yes with no, he with she,
and will with would. It also made even the
simplest email very hard without leaving out small words like the and of. But I am thankful I had a good kind of aphasia, one that
left my comprehension and reading intact. In any case, it has gotten a lot better
over the years.
But
my apraxia is another story. It
still plagues me with every word I speak. That is why I speak so slowly, so
deliberately. That is why I must think about every word, every syllable, every
sound.
All
this, and no one has even heard of apraxia. Only 11% of stroke survivors even
have it. No one can relate to apraxia or really understand it – unless they
have it.
But
everyone can relate to aphasia. After all, aphasia is like having a word stuck at
the tip of your tongue … and everyone gets that from time to time. And lots of
people have heard about aphasia since Gabby Giffords was shot. Why, aphasia
even has its own month devoted to it (June).
But
to explain apraxia, you have to give
a detailed explanation of how speech happens. You have to say something like this…
- Speech begins with an idea of what you want to say.
- The words of what you want to say must be put in the right order and grammar.
- Then you have think about the sounds -- and the sequence of sounds -- that make up those words.
- All this information has to be translated into a series of highly coordinated motor movements of the lips, tongue, jaw, and palate.
- The brain must tell the muscles the exact order and timing of movements so that the words are properly said. In children, once those words are spoken repeatedly, the speech motor act becomes automatic. These speech motor-plans are stored in the brain to be easily accessed as muscle memories.
All
this is my preamble to saying apraxia is the loss of these muscle memories.
Stroke survivors like me who have apraxia have to slowly and with effort
relearn these motor plans – in effect, our whole childhood’s speech process has
to be relearned.
·
So when I hesitate now, it’s not because I don’t know what
to say; it’s because I have to think about how to make my mouth move to say it.
·
When I say a word over and over, it’s not because I am perseverating;
it’s because I am practicing – listening and making adjustments.
·
When I speak in a monotone, it’s not because I’m thinking
like a robot; it’s because I’m struggling with every syllable.
·
If I sound like I have a learning disability, it’s not
because my intelligence is faulty; it’s because my stroke reset my muscle
memories to a child’s.
And
that is why my voice has changed since my stroke. Stroke survivors all say that you never
realize how many things you take for granted until they’re taken away. This is
especially true of apraxia, since what it has taken away from you is so hard to
explain and so hard to do without.
But
I’m still working on my apraxia, making new pathways from my brain to my mouth
that hopefully will last a lifetime this time!
Thank
you.
-- Talk given in the “Communicative Disorders” class at University of California, and at the Program in Communicative Sciences and Disorders of Cal State, San Marcos, San Diego, 2012.