Apraxia vs Aphasia, the Complete Guide

Communication is a critical aspect of our lives. We use words to communicate our emotions, instructions, thoughts, and ideas. To do this, we use several parts of our bodies, including our brains, nerves, vocal cords, mouth, tongue, and jaw.

When any of these parts are affected, your ability to form, process, or say words may be affected. However, this is often more significant when your brain is affected, congenitally or through a brain injury. A congenital anomaly or brain injury can cause several speech disorders including apraxia and aphasia.

If you or your loved one experiences difficulty speaking or understanding speech after a brain injury or stroke, you may be dealing with aphasia or apraxia. Understanding their differences can help you get the right diagnosis and timely treatment. Here, we explore the difference between aphasia and apraxia, their symptoms, causes, and how they are treated.

Key Takeaways

• Aphasia affects your ability to understand and produce speech, while apraxia affects the planning and coordination of speech movements.
• Apraxia occurs when there’s damage to brain pathways responsible for planning and coordinating speech, but aphasia is often a result of damage to language areas in your brain.
• Both speech conditions can result from a stroke, traumatic brain injuries, and neurodegenerative conditions.
• Early diagnosis and treatment can significantly improve your communication abilities

Table of Contents

What is Apraxia?

What is Aphasia?

Apraxia vs. Aphasia: What are the differences?

Difference between Apraxia and Aphasia: Symptoms

Symptoms of Aphasia

Symptoms of Apraxia

Difference between Aphasia and Apraxia: Causes

Aphasia vs. Apraxia: Types

Aphasia

Fluent Aphasia

Non-fluent Aphasia

Apraxia

Childhood Apraxia of Speech

Apraxia of Speech vs. Aphasia: Diagnosis and Treatment

What is Apraxia?

Apraxia, also called verbal apraxia or Apraxia of Speech (1), is a common motor speech disorder where your brain experiences difficulty coordinating the muscles necessary for speaking.

When you want to speak, your brain sends signals to certain structures, instructing them on what to do to produce certain sounds or words. These signals may instruct your lips on the shape to take or instruct your vocal cords when to open or close. These organized movements help you to produce the sounds, syllables, or words you want.

In apraxia, the brain cannot send signals needed to coordinate the muscles of the lips, tongue, or mouth to produce sounds or intelligible words. This causes a mismatch in intention and execution. Simply put, your brain can know what to say, but can’t get the structures to form the words.

What is Aphasia?

Aphasia (2) is a language disorder that temporarily or permanently affects your ability to process or form words when certain parts of your brain are injured. Depending on the severity of aphasia, there may also be reading and writing difficulties. It is essential to note that aphasia affects only speech and does nothing to your intelligence.

Apraxia vs. Aphasia: What are the differences?

Apraxia of speech and aphasia can both have a major impact on communication affecting your level of understanding, reading, speaking, and writing. However, while they both cause speech impairments, they differ in several ways.

Difference between Apraxia and Aphasia: Symptoms

Symptoms of Aphasia

There are several symptoms of aphasia. You may experience different symptoms based on the type of aphasia, and the extent of brain damage. Some of the common symptoms of aphasia you may experience include.

• Problems understanding speech or other people’s conversations
• Struggling to repeat words or sentences
• Speaking incomplete or broken sentences – leaving out connecting words like “is.”
• Difficulty writing
• Difficulty remembering common words such as names of objects or animals.
• Saying long and incomprehensible sentences
• Making up words or adding irrelevant words to sentences.

Finally, you may or may not be aware of your symptoms depending on the type of aphasia you have. People who are aware of their symptoms are often frustrated by their inability to fluently express themselves.

Symptoms of Apraxia

Apraxia of speech can affect children and adults depending on the type and underlying cause. Some of the symptoms you may experience include.

• Slow and effortful speech
• Difficulty pronouncing long or complex words
• Making inconsistent mistakes in sounds and when pronouncing words, even in the same sentence.
• Poor and inconsistent tone, rhythm, and rate of speech
• Moving your jaws, lips, or tongue repeatedly, before speaking or making a sound
• Taking long and excessive pauses between syllables or words
• Applying equal or improper stress on words
• Problems imitating speech
• Affected children may experience difficulty writing, speaking, and reading

Difference between Aphasia and Apraxia: Causes

One of the primary differences between aphasia and apraxia is the underlying cause. Aphasia occurs as a result of damage to certain parts of your left brain – the left hemisphere (3). These parts are responsible for language skills such as speaking, writing, comprehension, and reading. Aphasia can be caused by a stroke, brain tumor, traumatic brain injury from falls or accidents, or neurological conditions like Alzheimer’s disease.

On the other hand, Apraxia of speech is due to neurological damage that disrupts the nervous pathways (4) responsible for planning and coordinating the muscle movements necessary for speaking. This damage can result from strokes, head trauma, brain tumors, or neurodegenerative disorders. Some studies (5) show that childhood AOS may be associated with genetics, however, this hasn’t been fully established. It is essential to note that apraxia is not caused by weakness of the muscles of the mouth, lips, tongue, or jaw.

Aphasia vs. Apraxia: Types

Apraxia and aphasia can manifest in several forms, each with varying symptoms and characteristics depending on the cause and severity.

Aphasia

Aphasia has been divided into two major types – Fluent and Non-Fluent Aphasia.

Fluent Aphasia

Fluent Aphasia, also known as Wernicke’s aphasia, occurs when there’s reduced blood flow or injury to your posterior temporal lobe causing symptoms like difficulty understanding what others say. Individuals with fluent aphasia can speak and make full sentences that are complex and unnecessarily long. However, the sentences do not make sense because the words are either wrongly used, made up, or irrelevant.

If you suffer from fluent aphasia, you may experience difficulty understanding spoken language and may be unaware of your communication problem. You may also find it difficult to repeat words or sentences. Depending on the severity, you may experience some reading difficulties and visual impairments.

Non-fluent Aphasia

Broca’a Aphasia, also known as non-fluent aphasia, is characterized by difficulty forming complete sentences or speaking fluently. This aphasia is often due to damage or impaired blood flow to the frontal lobe of your left brain – specifically, the inferior aspect, the area responsible for language.

Individuals with Broca’s aphasia (2) can understand words but struggle to express themselves or communicate. They communicate through short and broken sentences with missing connecting words like “ the” and “is.”  For instance, they may say “Want eat” instead of “I want to eat.”

Unlike in Wernicke’s aphasia, people with Broca’s aphasia are fully aware of their difficulties and may be frustrated by it. They may also suffer other symptoms such as weakness or paralysis of one part of their body, depending on the extent of brain damage.

Other Types of Aphasia

• Global Aphasia: Global aphasia is characterized by severe communication difficulties due to extensive damage to the part of your brain that’s responsible for language – it is the most severe type of aphasia. People with global aphasia find it difficult to understand simple sentences or words and have severely limited speech production. They are usually only able to say a few words or repeatedly say the same words.
• Anomic Aphasia: Anomic aphasia simply affects your ability to remember certain words or names of objects, animals, or common day-to-day items. However, it has little to no effect on speaking and understanding words or sentences.

Apraxia

Apraxia can be classified into two major types, each with unique symptoms and challenges.

Acquired Apraxia of Speech

Acquired AOS affects individuals across all age groups, but is more common among adults. It can occur after a stroke, head injury, or other neurological illnesses, and often results in several symptoms such as slow speech, difficulty pronouncing words, and problems with speech rhythm and timing.

Childhood Apraxia of Speech

Unlike Acquired AOS, Childhood AOS affects only children and is usually present from birth. This motor speech disorder impacts the child’s ability to speak, pronounce words, or imitate words. Although there’s no known cause of Childhood AOS, scientists believe that genetics may be implicated.

Apraxia of Speech vs. Aphasia: Diagnosis and Treatment

Diagnosis

Diagnosing aphasia and apraxia of speech requires comprehensive assessments from healthcare professionals such as speech-language pathologists (SLP) and neurologists – where an underlying neurological disorder is suspected. These evaluations may include standardized speech and language tests that assess speech production and language skills.

Other tests that may be required include neuroimaging such as MRI or CT scans of your brain, motor testing, and neurological exams.

Treatment

In aphasia, the treatment you receive depends on the type of aphasia, underlying cause, severity, and extent of damage. Generally, the treatment of aphasia focuses on improving your comprehension, language, and communication skills. It typically involves individualized or group speech and language therapy, consistent practice, and in some cases, the introduction of other modes of communication – boards or gestures. Additional techniques like constraint-induced aphasia therapy, medical intonation therapy (MIT), and adaptive technology use can also help to improve language recovery.

In contrast, Apraxia of speech treatment often involves intensive techniques and strategies aimed at improving the motor planning and coordination of muscle movement necessary for speech. Simply put, speech-language therapy teaches your muscles to move properly to produce the right sound and words. Apraxia therapy may include repetitive speech exercises and motor planning and execution training. Other techniques like articulatory kinematic intervention and PROMPT (Prompts for Restructuring Oral Muscular Targets) may also be used.

Children with apraxia of speech live with it throughout their lives and often require intense speech therapy and in severe cases, augmentative and alternative communication (AAC) materials and devices.

Conclusion on Aphasia and Apraxia

Although aphasia and apraxia cause speech and communication difficulties, they are distinct speech disorders with unique symptoms, causes, and treatments. Living with any apraxia of speech or aphasia can significantly affect your ability to express yourself and your quality of life.

As such, getting the support of a healthcare professional, staying consistent with therapy, and embracing help and support from loved ones and people with similar stories can improve your communication. Recovery may be tough and long, but you don’t have to go through the process alone.

Further reading  Aphasia vs Dysarthia

Written by Dr. Ori Otokpa, MBBS

Medically Reviewed by Dr. Danielle Kelvas, MD

References 

1. Ziegler, W. (2007). Chapter 13 Apraxia of speech. Handbook of Clinical Neurology, 88, 269-285. https://doi.org/10.1016/S0072-9752(07)88013-4
2. What is aphasia? — Types, causes, and treatment. (2017b, March 6). NIDCD. https://www.nidcd.nih.gov/health/aphasia
3. Riès, S. K., Dronkers, N. F., & Knight, R. T. (2016). Choosing words: left hemisphere, right hemisphere, or both? Perspective on the lateralization of word retrieval. Annals of the New York Academy of Sciences, 1369(1), 111–131. https://doi.org/10.1111/nyas.12993
4. Kearney, E., & Guenther, F. H. (2019). Articulating: the neural mechanisms of speech production. Language Cognition and Neuroscience, 34(9), 1214–1229. https://doi.org/10.1080/23273798.2019.1589541
5. Kaspi, A., Hildebrand, M. S., Jackson, V. E., Braden, R., Van Reyk, O., Howell, T., Debono, S., Lauretta, M., Morison, L., Coleman, M. J., Webster, R., Coman, D., Goel, H., Wallis, M., Dabscheck, G., Downie, L., Baker, E. K., Parry-Fielder, B., Ballard, K., . . . Morgan, A. T. (2022). Genetic aetiologies for childhood speech disorder: novel pathways co-expressed during brain development. Molecular Psychiatry. https://doi.org/10.1038/s41380-022-01764-8