Apraxia of Speech: Care Staff Guide to Communication After Stroke or Brain Injury

Imagine knowing exactly what you want to say but being unable to make your mouth form the words. That is the everyday reality for many people with apraxia of speech. It can follow a stroke or brain injury, and it is often mistaken for confusion, a language problem or a lack of effort. Care staff who understand apraxia of speech can reduce frustration, protect dignity and help people stay connected to the people around them. This guide, based on NHS speech and language therapy information, explains what apraxia of speech is and how to support communication.

What is apraxia of speech?

NHS speech and language therapy information describes apraxia of speech as a motor-speech disorder in which the messages from the brain to the mouth are disrupted, making it difficult to control the muscles used for speech. The muscles themselves are often working normally. The difficulty lies in planning and coordinating the movements needed to produce speech sounds.

This differs from other communication problems. Our guide to aphasia and communication support explains a language disorder, in which finding or understanding words is affected. A person can have apraxia of speech, aphasia, or both, and a speech and language therapist should assess which applies. Apraxia is also different from dysarthria, where the speech muscles are weak, and from problems with thinking and memory.

Causes

The NHS information explains that apraxia of speech occurs when the area of the brain that controls coordinated muscle movement is damaged. Causes include stroke, brain injury, brain tumours, dementia and progressive neurological disorders. Sudden changes in speech need urgent attention: new difficulty speaking with facial drooping or arm weakness could be a stroke. Call 999 and follow the guidance in our article on stroke recognition and the FAST test.

What it looks like

People with apraxia of speech may:

• find it hard to move the tongue, lips and jaw, with visible groping movements of the mouth as they try to speak
• speak slowly and haltingly, with an unusual rate or rhythm
• make inconsistent errors, saying a word correctly once but not when they try to repeat it
• find everyday phrases easier, especially when relaxed, for example saying "I'm well, thank you" with ease while struggling with more complex words

That last point catches many people out. Because some automatic phrases flow, staff may assume the person can speak fluently on demand and conclude they are being deliberately difficult or are not trying. In reality, automatic speech and deliberate speech are controlled differently, and the harder the person tries, the harder it can become.

Assessment and therapy

The NHS information says speech and language therapy provides targeted assessment and therapy for apraxia of speech. Approaches described include:

• Personalised therapy built around the person's own goals, for example saying family members' names
• Communication partner training to help family, friends and staff communicate more effectively
• Augmentative and alternative communication (AAC), such as alphabet charts, picture boards or apps, which therapists can assess for suitability
• Total communication, using drawing, gesture, writing and facial expression alongside speech

Care staff are an essential part of therapy because the practice happens in everyday moments, not just in sessions. Ask the therapist for a simple summary of what to do and what to avoid, make sure communication aids are charged, within reach and in use, and report any change.

Tips for the person

The NHS information suggests strategies that therapists commonly teach, and staff can gently prompt them:

• plan what to say and speak slowly
• use writing, drawing, pointing or facial expression alongside speech
• stay calm, take breaks, and avoid important conversations when tired
• break longer words into smaller chunks, use shorter words or rephrase
• some people find that speaking with a melody or singing helps words come out

Tips for family, friends and staff

The same NHS information recommends that communication partners:

• use yes/no questions to clarify meaning
• be patient and allow plenty of time
• state the topic, for example "Are we talking about the weekend?"
• repeat back what they understood to check it, and work on unclear parts
• avoid pretending to understand: try another approach or return to the subject later

Add to this the basics of good communication: reduce background noise, face the person, make eye contact, and never talk about them as if they were not there. Avoid finishing their sentences unless they invite you to, and do not speak louder or more slowly as though they cannot understand. Their understanding is usually intact.

Emotional impact

Being unable to speak as you wish is exhausting and can be isolating. People with apraxia of speech may withdraw, avoid conversation or become frustrated, tearful or low. Notice changes in mood and appetite and raise concerns with the care team. Because many people with apraxia of speech have had a stroke or brain injury, depression is common, and our guide to acquired brain injury in care homes explains the wider emotional and cognitive effects.

Making environments communication-friendly

• offer choices using objects, pictures or written options
• keep a communication passport or profile that describes how the person communicates and what helps
• make sure communication aids go with the person to appointments and hospital stays
• give time for answers in meetings, reviews and care planning, and check that the person's views are recorded in their own words wherever possible

Frequently asked questions

Does apraxia of speech mean the person has dementia or cannot understand?

No. It affects the planning of speech movements, not understanding. Some causes, such as dementia, can affect thinking too, but the speech difficulty on its own does not signal lack of understanding.

Can people improve?

Therapy aims to improve speech or give people effective ways to communicate. Progress varies, so ask the speech and language therapist about the individual's goals.

Who should I ask for help?

Speak to the person's GP or the speech and language therapy service about assessment, and ask your manager about local referral routes.

Keep building your knowledge

Good communication support changes lives. Explore the health and social care learning available through Learnsignal CPD to keep your knowledge up to date.

This article is general information for care staff, based on published NHS guidance, and does not replace the advice of a person's own clinicians.