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Apraxia After Brain Damage: Causes, Symptoms, and Treatment

doctor showing patient info about apraxia after brain damage on her tablet

Apraxia is a possible secondary effect of brain damage that causes difficulty with executing coordinated muscle movements.

Apraxia can manifest in a number of different ways, depending on where the brain damage occurred. The most common type of apraxia is buccofacial or orofacial apraxia, which affects the orofacial muscles causing difficulty with mouth/facial movements such as winking, coughing, etc. This type can also include difficulties with speech (apraxia of speech).

This article will explain the different causes and types of apraxia after brain injury, plus some helpful treatments.

Causes of Apraxia After Brain Damage

Apraxia is a neurological disorder that causes problems with motor planning. In other words, it makes it difficult for a person to perform complex tasks that require coordination of diverse muscle groups, despite having the muscular ability to do so.

It differs from other movement disorders in that the person can understand what movements they must make, they just cannot execute them.

The exact cause of apraxia is debated. However, it is thought that one very likely cause is a defect in the brain pathways that contain memories of learned patterns of movement. It may also be caused by damage to the parts of the brain responsible for muscle movement and coordination, particularly the cerebellum and the posterior parietal cortex.

If these brain regions become damaged, muscle coordination may be difficult, if not impossible.

Types of Apraxia Following Brain Damage

There are several different types of apraxia that can develop after brain injury, and these types can occur together or separately. The type of apraxia that develops depends on which part of the brain sustains damage. For example, damage to the basal ganglia will cause a different type of apraxia than damage to the primary motor cortex would.

Some of the most common types of apraxia include:

  • Limb-kinetic Apraxia: This type refers to the inability to make fine, precise movements with your arms or legs.
  • Ideomotor Apraxia: This causes difficulties in performing the proper movements in response to a verbal command.
  • Ideational Apraxia: The inability to coordinate activities with multiple, sequential parts such as dressing, eating, bathing, and other activities of daily living.
  • Verbal Apraxia: Also known as apraxia of speech, this type causes difficulties with coordinating facial movements to form words.
  • Oculomotor Apraxia. Finally, apraxia can also affect the eye muscles themselves, making it difficult to move the eyes correctly.

Fortunately, all of these types of apraxia can typically improve to some degree with physical, speech and/or occupational therapy.

Symptoms of Apraxia

Symptoms of apraxia will look different based on which type of apraxia the person has. For example, a person with limb-kinetic apraxia may have difficulty with walking or may struggle to pick up objects with their arms.

For apraxia of speech in particular, symptoms can include:

  • Exaggerated movements of the lips and tongue (called groping)
  • Slowed speech
  • Distortion of vowel sounds
  • Difficulty stringing syllables together
  • Incorrect inflections
  • Omitting consonants at the beginning and end of words

Apraxia of speech is often accompanied by aphasia, a language disorder. However, apraxia itself does not cause problems with speech comprehension or production.

Treating Apraxia of Speech After Brain Damage

Apraxia is a result of poor communication between the brain and muscles. Because of this damage, the signals that the brain normally sends to coordinate movement does not reach the correct muscles.

Treatment for apraxia of speech revolves around restoring this communication between the brain and the rest of the body. Fortunately, this can be done by activating neuroplasticity, which is your brain’s natural ability to rewire itself.

Neuroplasticity is experience-dependent, which means it occurs based on whatever you experience on a regular, consistent basis. When you practice a task, even if you can’t do it perfectly, your brain forms new neural pathways in response.

After enough experience is achieved, the new pathways become more established and the connection to your muscles may return. This will allow you to improve your coordination. 

This technique will work with all types of apraxia. Since, however, apraxia of speech is very common, we will show you a few speech therapy exercises that you can do at home.

Exercises for Apraxia of Speech

The best way to overcome apraxia of speech is to work with an expert called a Speech Language Pathologist. These experts are specifically trained to improve disorders related to speech/language.

In between therapy sessions with your SLP, it’s a good idea to practice speech therapy exercises on your own at home.

Here are some examples of exercises for apraxia of speech:

Lip articulation exercises for apraxia of speech

therapist teaching patient how to do lip articulation to treat apraxia after brain damage

This first set of exercises will improve your lip control. Some of the best exercises for this include:

  • Make the sound “ooo” while forming your lips into an O shape. Then make the sound “eee” while attempting to coordinate your lips into a smile. Finally, combine the two sounds and say “ooo-eee.”
  • Next try to make a popping sound with your lips by making the sound “puh.”
  • Another great activity for apraxia patients is sipping water through a straw. This requires coordination between your lips, cheeks, and tongue.

Tongue articulation exercises for apraxia

These exercises will help you regain better control of your tongue. A few activities that a speech therapist might suggest include:  

  • Place the tip of your tongue right behind your upper front teeth. Hold it there as long as you can.
  • Without moving your jaw, say “la la la la” by moving just the tip of your tongue from the roof of your mouth.
  • Form an O shape with your lips. Then, place your tongue on the left corner of your lip and trace it all the way around your lips. When you complete the circle five times, switch to the other direction.

Coordination exercises for apraxia

After you have practiced articulation exercises, you can combine your skills together and practice coordination. Here are some coordination exercises that you can use:

  • The words “buttercup” and “rocket ship” require particularly coordinated movements. Try saying “buttercup” 5 times followed by “rocket ship” 5 times.
  • Next, try saying “puh, tuh, kuh” three times. You can start slow, but try to increase your speed gradually.

These exercises will get you started on your way to overcoming apraxia of speech.

Understanding Apraxia After Brain Damage

Apraxia is a motor disorder that makes it difficult to perform purposeful movements, such as speech. It occurs after damage to parts of the brain in charge of motor control.

By engaging neuroplasticity through exercise, however, it may be possible to treat apraxia and regain full control of your muscles.

Featured Image: ©iStock/Lordn

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