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.