Treatment for Apraxia
Speech and language therapy delivered by a speech-language pathologist is the recommended treatment for apraxia, with specific approaches varying based on whether the condition is childhood apraxia of speech (CAS) or acquired apraxia of speech (AOS) in adults.
Acquired Apraxia of Speech (Post-Stroke)
Core Treatment Approach
All healthcare providers working with stroke patients should be trained to recognize apraxia of speech and other communication disorders 1. Patients with suspected apraxia should be referred to a Speech-Language Pathologist (SLP) for comprehensive assessment using valid and reliable methods 1.
Treatment Intensity and Timing
- Start therapy as early as tolerated after stroke onset 1
- Early access to intensive speech therapy according to individual needs, goals, and impairment severity is recommended 1
- Treatment should focus on production and/or comprehension of words, sentences, and discourse 1
Specific Therapeutic Techniques
Sound Production Treatment (SPT) using an articulatory-kinematic approach has demonstrated superior outcomes compared to other methods, with better long-term maintenance of gains 2. This behavioral treatment approach showed positive changes in articulatory accuracy with generalization to untreated words containing the targeted speech sounds.
Gesture training as described by Smania and colleagues can be recommended because effects extend to activities of daily living and persist for at least two months after completion 3. This addresses the motor planning deficits underlying apraxia.
Supplementary Approaches
- Computerized treatment may be considered to supplement SLP-provided therapy 1
- Group therapy can supplement intensity during hospitalization or serve as continuing therapy after discharge 1
- Non-verbal strategies, assistive devices, and technology (tablets, computer-guided therapies) may be incorporated 1
Treatment for Progressive Apraxia
For apraxia associated with nonfluent variant primary progressive aphasia, structured oral reading treatment has shown reduction in speech errors with maintenance at one year post-treatment and generalization to repetition tasks 4.
Childhood Apraxia of Speech (CAS)
Treatment Intensity Requirements
Higher intensity treatment (2 sessions per week minimum) is necessary for significant outcomes in CAS 5. Research demonstrates that:
- 2×/week treatment led to significantly better outcomes for articulation and functional communication compared to 1×/week 5
- Effect sizes were consistently larger with higher intensity treatment 5
- Lower intensity (1×/week) did not produce significant improvements 5
Specific Treatment Protocol
Rapid Syllable Transitions (ReST) treatment delivered twice weekly for 6 weeks produces significant retention of treatment effects to 4 months post-treatment with generalization to untrained speech behaviors 6. However, four times weekly therapy may provide small additional benefits with ongoing improvement after treatment cessation 6.
Motor Speech Intervention Approach
Individual motor speech intervention should target:
- Articulation accuracy
- Functional communication skills
- Multisyllabic word production
Treatment should use structured, repetitive practice with immediate feedback on articulatory accuracy.
Common Pitfalls to Avoid
Do not rely solely on general perceptual judgment for diagnosis—use standardized assessment tools and expert evaluation to confirm apraxia before initiating treatment 1
Avoid insufficient treatment intensity—particularly in children, where 1×/week therapy has been shown ineffective 5
Do not focus exclusively on speech intelligibility as the primary outcome measure, as neither lower nor higher intensity treatment yields significant changes in intelligibility at word or sentence level in the short term 5
Avoid interrupting normal automatic movement patterns through excessive conscious focus on movement, which can cause maladaptive functioning 7
Do not neglect concomitant conditions—apraxia frequently co-occurs with aphasia and dysarthria, requiring integrated assessment and treatment planning 1
Assessment Requirements Before Treatment
Before initiating therapy, SLP assessment should evaluate:
- Comprehension and speaking abilities
- Reading and writing skills
- Gesturing and use of technology
- Pragmatic communication (social cues, turn-taking, body language)
- Conversational abilities 1
Goals should be identified collaboratively with the patient and family/caregivers, documented clearly, and reassessed at appropriate intervals 1.