Spotlight on verbal dyspraxia

Verbal dyspraxia is a complex neurological speech disorder affecting a person's ability to plan, coordinate and perform the necessary muscle movements required for speech. Difficulties result from problems in the part of the brain responsible for planning the muscle movement patterns needed for speech, as opposed to other speech disorders such as dysarthria caused by physical muscle damage.

Verbal dyspraxia does not affect a person’s ability to understand but can significantly impact communication skills and cause challenges in expressive and receptive language abilities. People with the condition can often complete automatic speech exercises such as counting or repeating familiar phrases but face challenges with conversational speech that is unstructured.

Presentation of verbal dyspraxia

Verbal dyspraxia can be present from birth or acquired later in life due to a brain injury resulting from a stroke, illness, seizure, accident, or other trauma. Symptoms range in severity and can vary from day to day depending on factors including fatigue, medication, mood, and levels of stress and anxiety.

Inconsistent speech errors: Unlike other speech sound disorders, children with verbal dyspraxia may produce the same word differently on various occasions. This inconsistency can lead to frustration for both the child and their listeners.
Difficulty with sequencing sounds: Children may struggle to sequence sounds in words, leading to mispronunciations or omissions. For example, a child might say "top" instead of "stop.
Groping movements: There may be visible groping or hesitation as the child attempts to position their lips, tongue, and jaw to produce speech sounds, indicating difficulty in motor planning.
Limited vocabulary: Due to their speech difficulties, children may have a reduced vocabulary and avoid speaking altogether, opting for gestures or alternative communication methods.
Variability in speech clarity: Some children may have clear speech at times, while at other moments, their speech may be markedly unclear, further complicating communication.
Frustration and anxiety: The challenges associated with verbal dyspraxia can lead to emotional responses, including frustration or anxiety, particularly in social situations where effective communication is vital.

Assessment from speech and language therapists

Once a diagnosis of verbal dyspraxia is established, the assessment of needs can be impacted by various factors, and speech and language therapists play a pivotal role in providing targeted intervention. The support offered may include:

Therapy plans: Developing tailored therapy plans that address the specific needs of the individual, focusing on improving speech clarity, sound production, and overall communication skills.
Motor planning exercises: Introducing exercises to enhance the ability to plan and execute the movements required for speech. These may involve repetitive practice of specific sounds or words in a structured manner or informal chats to aid spontaneous speech.
Visual and auditory cues: Incorporating visual aids, such as pictures or gestures, alongside auditory cues to reinforce learning and help understand the relationship between sounds and their corresponding movements.
Family and caregiver training: Educating family and caregivers on techniques to support communication at home, school, or in the workplace. A better understanding of the disorder among close relatives and care teams can encourage speech, increase the use of alternative communication methods, and help foster a supportive environment.
Monitoring progress: Regularly assessing progress and adjusting therapy goals as necessary to ensure continued development and success.
Collaboration with multidisciplinary teams: Working closely with psychologists, psychiatrists, occupational therapists, and other specialists to assess the holistic needs of each client and design a care package spanning physical, emotional, social, and other considerations.

In highlighting the approach to therapy and the role of speech and language therapists in assessing verbal dyspraxia, Charlotte adds:

Speech and language therapists are often at the forefront of therapeutic interventions, serving as the foundation for other therapies, such as Cognitive Behavioural Therapy (CBT), as the success of these therapies relies on an individual's ability to communicate. While verbal dyspraxia cannot be cured, our treatments often focus on repetition and training the brain to make muscle movements automatic, so communication becomes easier and requires less conscious effort.

Introducing Charlotte Litherland

Charlotte is a highly skilled speech and language therapist with experience assessing and treating communication, speech, and language difficulties in children and adults. Her clinical roles have included working with individuals facing communication challenges, and she has a successful track record of planning, implementing, and coordinating therapy programmes related to communication and dysphagia.

In addition to her clinical work, Charlotte has developed and delivered training programmes on topics including autism, communication, dysphagia, Makaton, Positive Behaviour Support, and sensory integration. She has also managed teams of speech and language therapists and therapy assistants.

Charlotte currently serves as a consultant speech and language therapist and behaviour support practitioner for the British Institute for Learning Disabilities, as well as the lead speech and language therapist at Elysium Healthcare. In these roles, she works with adults facing a range of challenges, including mental health issues, acquired brain injuries, degenerative conditions, autism spectrum disorders, learning difficulties, and deafness. Additionally, Charlotte operates as an independent therapist, providing assessments and treatment for various speech, language, and communication disorders.

Charlotte is fluent in Makaton and has experience addressing communication issues related to hearing loss. She holds several qualifications, including a BSc (Hons) in Clinical Language Sciences (Speech and Language Therapy), an M(Ed) Autism with Distinction, and a postgraduate Diploma in Sensory Integration. In addition, she is a member of the Royal College of Speech and Language Therapists and the Health and Care Professions Council.

Charlotte is currently involved in an active case concerning a stroke victim in her late 60s who has acquired verbal dyspraxia and requires assessment to determine her capacity to consent to legal proceedings related to her care in hospital. Charlotte's assessment strategy is multifaceted and focuses on the client's ability to evaluate, reason, and comprehend the legal implications of her situation.

Following an initial evaluation to assess the client's speech clarity and consistency, Charlotte coaches the client on moderating their speech rate, recognising the impact of rapid speech on the client's ability to articulate thoughts and formulate responses. Breathing techniques have also been introduced to assist in managing anxiety and improving speech production, promoting relaxation and supporting clearer pronunciation.

The care package designed for the client includes training for her legal team on effective communication strategies, including moderating speech speed and using clear language, together with visual aids that simplify the legal process and enhance understanding. The client has been cleared to participate in litigation and Charlotte maintains scheduled meetings to monitor the client's progress and adjust her strategies as needed to ensure her continued engagement and understanding.

Expert witness reports from Bush & Co.

Bush & Co. offers comprehensive speech and language expert witness reports prepared by qualified speech and language therapists who possess extensive experience in assessing communication disorders. Reports include a detailed prognosis, with assessment considering the nature and severity of the speech and language difficulties, as well as the potential for improvement through therapeutic interventions. Also provided is an analysis of verbal and non-verbal communication, comprehension, articulation, and the ability to engage in social interactions, which serves to illustrate how effective communication is integral to overall functioning.

Speech and language expert witness reports deliver valuable insights that contribute to medico-legal proceedings and play a crucial role in ensuring clients receive the support they need to enhance their communication skills and overall well-being.