7/20/2025
This week, I’ve worked with two adult patients with long term effects of CVA (stroke) and subsequent apraxia of speech. Apraxia describes a deficit in the motor planning of speech. As a result, patients lose the ability to form words – even the ones that seem easy.
My two patients – we’ll call them Gin and Jack – are classically different. They don’t share the same gender, cultural traditions, upbringing, race, nor language. They’re also about 20 years apart in age. Yet, they share the same classical post-stroke symptoms and almost the exact same presentation in their language and speech output. Gin’s a bit more easily frustrated with her symptoms because she’s outgoing, while Jack is more of a “fly-solo” type of guy.
Either way, for both, being unable to form words definitely doesn’t ever get normalized, nor comfortable, and CVAs don’t play fair.
TLDR:
Scaffolding phrases. So, no, these do not have to be common phrases. With acquired apraxia, a common treatment method is using everyday phrases to rebuild the lexicon, essentially scanning the practiced phrases for use in a functional situation (i.e. Good morning, or I need help). Scaffolded phrases build the lexicon, as well, by structuring the different parts of speech to make useful sentences. First, the patient or therapist chooses an item in the immediate environment. Then, one word is combined with another word from another part of speech to make a partial phrase. Next, a longer phrase is created by adding additional parts of speech.
Example: Table. Wooden table. Brown wooden table. The brown wooden table broke.
This can be repeated as long as appropriate for the patient. After successful repetition at each level, the patient can move on to another single item to attempt to scaffold more phrases.
Note: Words are added to the beginning or end of already successful phrases. If a phrase is not successfully imitated, it is not reasonable to add more words. At the end, a complete sentence or thought with appropriate grammar is most useful, so it can be directly applied to communication. It is best to avoid scaffolding complex sentences or phrases that wouldn’t support that. For example, Broke the wooden table would leave out a necessary subject. Break the wooden table can be scaffolded to use in a longer phrase I broke the wooden table.
The phrases are not meant for memorization or rote practice, as they are with common treatment methods for apraxia. In fact, this approach can be considered more developmental in nature than restorative.
With Jack, I found it helpful to use a word-bank to facilitate more independence with scaffolding. I’d give him a word, and he would combine it with a word from the bank. It helps that he was literate after his stroke, which not all will be. As always, you meet the patient where they are. Modeling is key, and repetition is fundamental. When a patient has been asked one thousand times, What color is it?, the thousandth time they may likely have a better answer than I don’t know. By the thousandth time, the patient and therapist have built an understanding and reasonable expectations. By the thousandth time, the patient has accustomed themselves to using a strategy rather than giving up.
If you have questions or comments about this therapy technique of the week, please write a note below or reach out via email at info@mytattletalesspeech.com.
Happy Treating.
Tattletales Speech and Early Intervention Services 