Dyspraxia in adults can occur as a result of a brain injury, causing the adults to lose their ability to speak and swallow. This may be due to a wide range of diseases or injuries.
Many parts of the brain are required to act together for speech and swallowing to work properly. No single part of the brain is responsible. So that there are many parts of the brain which, if affected, can make speech or swallowing difficult.
One of the possible consequences of brain injury or disease is dyspraxia (or apraxia). For speech to occur a person must first have know the concept they wish to talk about, know the words and the sentence structure, plan out how to execute it and then to say it. It is possible for people to have the concept, and even to know the words, but not to be able to do it. This is when an adult has dyspraxia.
Sometimes an adult with dyspraxia can have completely normal comprehension. More usually there will be some difficulty with understanding at least some words or complex sentences. Please do not assume that someone fully understands everything they hear just because they seem to respond appropriately when you talk to them.
Dyspraxia in adults can take several forms. Most people who have dyspraxia as a result of a CVA (stroke) are initially unable to talk, or may be able to make just a few sounds. These sounds are often repeated over and over, like “di di di”. It may seem as though the person knows what they want to say but can’t say anything, even the names of their family.
A word that is often heard in relation to people with dyspraxia who are trying to talk is ‘groping’. This is when they appear to be trying to put their mouth how it needs to be for speech but not being successful with producing clear talking.
Some people with dyspraxia can be highly verbal and are able to produce a long string of utterances – but it doesn’t make sense. This can be like a word ‘fruit salad’. Sometimes these people even think they are saying what they want to say.
Other people with dyspraxia can speak reasonably well some of the time or most of the time, but every so often they try to say a word and out comes a different word altogether – for example they wish to ask for the TV remote but ask for the banana instead.
Dyspraxia can be classified as severe, moderate or mild, depending on how impaired communication is.
One of the most noticeable things about speech in dyspraxic adults is that occasionally a string of words or a phrase may come out, almost involuntarily. Sometimes this can be expletives – which is very disconcerting in people who have not generally spoken that way before! The brain is able, at times, to ‘short circuit’ the normal process of producing speech to produce this automatic speech.
Other kinds of utterances that are considered automatic speech are very well known and rehearsed groups of words – counting, the days of the week, the months of the year, proverbs. Often people with dyspraxia will find this kind of speech the easiest if someone starts them off.
Adults with dyspraxia find it hard to make sounds and to put sounds together to make words and to put syllables together to make longer words. It will be easier to say words with certain sounds more than others, and shorter, simple words are easier to say than long complex words. Consonants in particular can be hard to say. They are often repeated or substituted for other sounds.
Adults with dyspraxia find it hard to imitate facial expressions and to imitate words. When repeating words they may repeat the same way a different time. It can be very frustrating to say a word correctly and then not to be able to do it again accurately.
And people who are able to speak will make inconsistent errors. The same word is not necessarily said the same way every time or from day to day.
An adult with dyspraxia needs to work intensively with a Speech Pathologist. It is often possible to improve communication in people with dyspraxia. Some people make a full or almost full recovery. There are also strategies that can be used by other people to make it easier to communicate with people with dyspraxia.
Adults with dyspraxia often rely on the ‘tune’ in their voice, or in your voice, to help them talk. A term that is used by Speech Pathologists is ‘prosody’. This relates to the upsand downs of pitch in the voice, the rhythm, stresses on syllables and emphasis on words that we all use when we talk.
Very often, people with dyspraxia who cannot talk can actually sing. This can be used by Speech Pathologists to help people with dyspraxia talk. Family members or carers can be shown how to use the tune in speech to help people talk.
Dyspraxia in adults often results in swallowing problems, as well as speech difficulties. This is because a swallow also requires a motor program to plan and execute it. If someone’s swallow is not well coordinated then the airway can be open while they are swallowing and food or fluid can go into the lungs. This usually results in pneumonia.
Difficulty swallowing is called dysphagia. It is managed by a Speech Pathologist in acute hospital settings initially or later in the community or a residential facility. Often a person may require non-oral feeding or modification of the food or fluid that the person is able to safely swallow without taking it into their lungs. Usually a swallow improves, either fairly quickly or else over time. A swallow can often be rehabilitated faster than speech.