Apraxia: Symptoms, Causes, Tests, Treatments

Medically Reviewed by Jabeen Begum, MD on November 21, 2023
Written by Sarah Ludwig Rausch
8 min read

Apraxia is a neurological condition that makes it difficult or impossible to make certain movements. This happens even though your muscles are normal and you have the understanding and desire to make these movements.

It's caused by damage to your brain that keeps it from forming and giving instructions to your body. It can affect you in several different ways, depending on what type you have.

Dyspraxia

Milder forms of apraxia are known as dyspraxia. This condition starts in childhood and causes problems with movement and coordination. It can affect both your fine and gross motor skills, as well as your balance and motor planning. This may make it hard to do things like riding a bike, writing, or tying your shoe. Dyspraxia isn’t as severe as apraxia because you only lose part of your motor ability. With apraxia, you totally lose your ability to make certain movements. You might also hear dyspraxia called developmental coordination disorder (DCD).

 

There are multiple forms of apraxia, and each affects your body differently. 

Apraxia of speech

With apraxia of speech, sometimes called verbal apraxia, it's hard or impossible to move your mouth and tongue to form words. This happens even though you have the desire to speak and your mouth and tongue muscles are physically able to form words. There are two forms of apraxia of speech -- acquired apraxia and childhood apraxia of speech:

  • Acquired apraxia of speech. Also known as verbal apraxia or oral apraxia, it can affect people of all ages, though it's usually found in adults. It causes you to lose the speech-making abilities you once had. When it affects adults, it's sometimes called adult apraxia of speech.
  • Childhood apraxia of speech. This is a motor speech disorder that you're born with. It affects a child's ability to form sounds and words. It isn’t a muscle issue; it happens because your child’s brain has a hard time planning for and directing the movements of their lips, jaw, and tongue. Children who have it are often far better at understanding speech than at expressing themselves with spoken words. Most children with childhood apraxia of speech can get much better, if not recover completely, with the right treatment.

Oral apraxia

This disorder affects the movements of your jaw, lips, tongue, and palate. Along with speech issues, it can cause problems with eating and drinking.

Ideational apraxia

With this condition, your brain can't make a plan for motor tasks that require multiple steps, such as brushing your teeth.

Ideomotor apraxia

This is the most common type of apraxia. When you have it, you’re unable to follow instructions or copy the actions of someone else to make movements with your head, arms, or legs. This includes things such as waving and using a hammer.

Conceptual apraxia

This is similar to ideomotor apraxia, but it’s more serious because your brain doesn’t understand how tools are used. For instance, you may try to use a hammer as a screwdriver or a pen.

Buccofacial apraxia

Also known as orofacial apraxia, this condition makes you unable to voluntarily make certain movements involving your facial muscles. For instance, you may not be able to lick your lips or wink.

Oculomotor apraxia

With this condition, you have a hard time moving your eyes in the direction you want.

Constructional apraxia

When you have constructional apraxia, you can’t draw or copy simple shapes or build simple objects.

Limb-kinetic apraxia

With this condition, you have a hard time moving a finger, arm, or leg exactly the way you want to. For example, you may be unable to button a shirt.

Apraxia is sometimes confused with aphasia, another communication disorder. That confusion can be complicated by the fact that the two conditions can occur together.

People with apraxia and aphasia might both have trouble expressing themselves with words. But there are differences between the two conditions. Aphasia is a condition that affects your ability to understand or use words effectively. This may make it hard to speak, read, or write.

But apraxia isn't a problem with understanding language. It's when you have a hard time starting and completing the movements needed to speak. This happens even though you don't have weakness in the muscles you use to speak.

The main symptom of apraxia is being unable to make voluntary movements or gestures even though you have the physical ability and understanding to do so. The types of movement and the muscle groups that are affected depend on the part of your brain that’s involved.

Depending on what type you have, symptoms may include issues with:

  • Facial movements such as coughing or winking
  • Precise movements using your finger, arm, or leg
  • Using specific tools for specific tasks
  • Moving your eyes
  • Carrying out complicated tasks such as brushing your teeth or tying your shoe
  • Mimicking movements with your head, arms, or legs
  • Taking small steps
  • Copying simple drawings

Apraxia of speech can affect the way you speak in several different ways. Early signs of apraxia of speech in children may include:

  • Very little babbling (in infants)
  • Little variety in the sounds they make
  • Omitting sounds within words, especially at the beginning of a word
  • Being able to say a sound or word properly at certain times but not always
  • Losing the ability to say a word they already learned
  • Often using nonverbal forms of communication, such as nodding or pointing

Childhood apraxia of speech often comes with other language or thinking and memory deficits, which may bring symptoms such as:

  • Trouble chewing and swallowing
  • Clumsiness

If you have adult apraxia of speech, you may

  • Speak slowly
  • Say one word when you mean another, like “kitchen” instead of “chicken”
  • Move your lips and tongue around a lot as you try to make certain sounds, a process called groping
  • Have no trouble with words or phrases you often say, like “good morning”
  • Lose the ability to make any sounds in serious cases

 

 

Apraxia happens when certain parts of your brain aren’t working the way they should, particularly the parietal lobe. This can be caused by some diseases, but it usually results from brain damage to areas of the brain that contain memories of how to perform learned tasks. Apraxia can also be caused by damage to other brain areas. Conditions that can lead to apraxia include head trauma, stroke, dementia, and a brain tumor.

Experts don't yet understand what causes childhood apraxia of speech. Some scientists believe it results from signaling problems between the brain and the muscles used for speaking.

Ongoing research is focusing on whether brain abnormalities that cause apraxia of speech can be identified. Other research is looking for genetic causes of this type of apraxia. Some studies are trying to determine exactly which parts of the brain are linked to the condition.

Tests that may be used to diagnose apraxia include:

  • Evaluation by a doctor: Your doctor will ask you to do familiar tasks that you’ve learned, such as brushing your teeth or cutting out a shape. An evaluation will also include a physical exam to see if your symptoms are due to problems with your muscles or joints. Your doctor may talk to your family members as well to find out how well you're able to do your normal daily activities.
  • Brain function tests: Your doctor may use neuropsychologic tests to check how your brain is working in areas such as problem-solving, memory, language, attention, and processing.
  • Imaging tests: If your doctor believes your apraxia is caused by damage to your brain, you may have imaging tests such as a CT scan or MRI to find the extent and location of the damage.

Your doctor may look for other symptoms too. For instance, they may check for muscle weakness or difficulties with language comprehension. This helps them determine whether you might have another condition instead of apraxia.

Diagnosing childhood apraxia of speech

There's no single test or procedure that is used to diagnose childhood apraxia of speech. Diagnosis is complicated by the fact that speech-language pathologists have different opinions about which symptoms indicate the condition.

Most experts, though, look for multiple, common symptoms. They may assess your child’s ability to repeat a word multiple times. Or they may see if your child can recite a list of words that are increasingly more difficult, such as “play, playful, playfully.”

A speech-language pathologist may interact with your child to determine which sounds, syllables, and words they're able to make and understand. The pathologist will also examine your child's mouth, tongue, and face for any structural problems that might be causing symptoms.

Usually, a diagnosis can't be made before your child's second birthday. Before this time, most kids are unable to understand or perform the tasks needed to determine whether they have apraxia.

There's no particular treatment for apraxia, and it can’t be cured. But it can be managed with physical, speech, and/or occupational therapy. These therapies can improve your symptoms and make apraxia easier to live with.

If another condition is causing your apraxia, you'll get treatment for that condition. In some cases of acquired apraxia, the condition goes away on its own.

But that's not the case with childhood apraxia of speech, which doesn't improve without speech-language therapy. Most children with apraxia of speech benefit from seeing a speech-language pathologist three to five times a week. Your child may also work with you to practice the skills they're developing. For the best results, the treatment should be designed to meet your child’s particular needs.

Therapy for childhood apraxia of speech aims to improve speech coordination. Apraxia speech therapy activities may include:

  • Repeatedly practicing forming and pronouncing sounds and words
  • Practicing stringing together sounds to make speech
  • Working with rhythms or melodies
  • Using multisensory approaches, such as watching in a mirror while trying to form words or touching the face while talking

If your child’s apraxia of speech is serious, they can also learn alternative ways to communicate, such as writing, drawing, or pointing. Another option is to use assistive electronic devices, including computers that can produce words and sentences.

Many therapists believe sign language is helpful for children who have trouble being understood. They often recommend that children try to say the words they're signing, helping them practice making mouth movements. People with more serious cases of acquired apraxia may also benefit from sign language or computers.

Very few studies have been done to determine how effective different treatments for childhood apraxia of speech are. This may be due, in part, to disagreement among experts about which symptoms should lead to a diagnosis of apraxia.

When you have apraxia, you have a hard time making certain movements. It happens when damage to your brain keeps it from giving the right instructions to your body. Different types of apraxia affect you in different ways. There's no cure, but physical, speech, and occupational therapy can improve your symptoms and make the condition easier to live with.

What’s the likely outcome for a person with apraxia?

With therapy, some people get considerably better. Others may not see much progress or even get worse. It all depends on the person, how serious their apraxia is, and what's causing it.

What’s the most common cause of apraxia of speech?

Childhood apraxia of speech (CAS) may be caused by genetics or a brain injury from conditions such as childhood stroke, epilepsy, or infection. Unfortunately, the cause of CAS is unknown in most children. In adults, apraxia of speech is usually caused by brain damage. However, CAS can carry over into adulthood, as it is a chronic condition.