Lonely in a crowd

I visited a person with aphasia today. This lady had mild to moderate aphasia, but severe apraxia. She understands situations and simple sentences, but cannot say a word on her own. While I was there, the visiting nurse came with a translator. The nurse, translator, husband and sister all sat in the living room with the patient. They all talked to each other, but not one remark was made to the person with aphasia. Once or twice she tried to enter the conversation by vocalizing, but she was ignored. This family is very caring, a lovely family. They tell me, "She understands everything." The nurse is also a good person. It just showed how difficult it is to include someone in education, decision-making, even conversation, when that person doesn't speak. Language is so much a part of us that we cannot even imagine not having it. And when someone cannot speak, it is hard to remember that they can still think - and feel.

Treatment for "fluent apraxia"

Yesterday I wrote about two people who had difficulty sequencing phonemes, with some symptoms similar to apraxia. One of them spoke better if she spoke slowly. She used this strategy to improve over the course of speech therapy.

The other did not improve when she spoke slowly. There was no improvement with repetition or melodic intonation therapy, either. If you have had success with treating this type of speech problem, I'd love to hear from you!

Fluent apraxia?

The purpose of this blog is to reflect on aphasia, aphasia therapy and the brain. I hope that this blog will stimulate conversation about aphasia - especially among people who experience aphasia on a daily basis. Whether you are a survivor, a co-communicator, or a professional, you have important insights to share with others!

A "Fluent apraxia"?

Recently I met two people with aphasia who did not fit into the usual traditional categories of aphasia They both had good comprehension. Their speech was worse when they were saying a longer word, or a word they didn't use very often. They were very aware of their errors. So far it sounds like apraxia.

However, they had fluent speech with many phonemic paraphasias. In other words, the nonsense words sounded similar to the real word they were trying to say. Repetition was just as affected as spontaneous speech. One person found that if she spoke slowly, her speech was better. These symptoms sound like fluent aphasia.

Theoretically, I wonder if this problem is on the border of speech and language, at the level of phonemic sequencing. There is a theory that we first decide what we want to say, then we sequence the phonemes (sounds) that we need to produce to express the sentence, and then send instructions to the muscles to produce the sounds. Apraxia means there is a problem with sending the instructions to the muscles. Is there a name for the problem that only involves sequencing the phonemes?