Giving a voice to individuals with apraxia of speech
Finding the right therapy for you
Adult therapies
These therapies are designed specifically for adults with apraxia of speech. They focus on improving speech clarity, motor planning, and communication confidence. Each approach provides structured strategies tailored to an individual’s specific needs.
Neurological disease /stroke speech apraxia support.
Stroke Language Therapy Groups
Stroke groups such as the Stroke Survivors Speech & Language Support Group offer help with speech and language post-stroke by a team of trained volunteers. They run groups over Cheshire, UK and have an online group and are a growing charity offering support in this area. Liz Bedson the CEO is also a Friend of Speech Apraxia, one of our fantastic team of volunteers. We are delighted to work in collaboration with this fantastic charity
Aphasia Re-Connect – Registered Charity Number 1176125
MedBridge – Acquired Apraxia of Speech: Research into Treatment Effects
A free YouTube introduction featuring Julie Wambaugh discussing research into acquired AOS treatment; useful as a short professional learning video rather than a complete course.
https://www.youtube.com/watch?v=hPnL3hfGY54
Adult Therapy Apps
Speech and Language Therapy Services around the world can be both restricted or expensive. Therapy apps can be a useful way of extending therapy. Adult apraxia of speech apps include Tactus Therapy and Cuespeak.Jon Hunt developed the Cuespeak app and is a Friend of Speech Apraxia, please do message questions about apps.(pictured is Jon Hunt creator of Cuespeak)
Think about
Recording capability?
Microphone or no microphone
Recording mechanism–Intensity/ repeated practice–Stimulus selection/ practice structure–Feedback–letting go
Self: playback
Automatic speech recognition
Lee Silverman Voice Technique
Although not a mainstream therapy method for speech apraxia, The Lee Silverman Voice Technique has been shown to be valuable in helping sufferers of primary progressive apraxia of speech. https://www.mdpi.com/2076-3425/14/5/417
Voice Banking
Individuals with primary progressive apraxia of speech might consider voice banking. Voice banking is where you can record yourself reading a set list of sentences, recording all the sounds needed for speaking. A voice banking provider then uses your recording to create a computerised version of your own voice. If needed this can be used on a communication aid so the voice sounds more like you.
If you have not been referred to a speech and language therapist (SLT) ask the health and social care professionals you are in touch with for one. It is useful to talk through your options around voice banking and AAC and to have SLT support during the process of voice banking. To bank your voice you will need access to the internet, a laptop or a PC and a headset microphone. Some services offer the ability to bank on a smartphone or tablet, however, others continue to suggest the quality of the recording is better when completed with a computer and a headset microphone We have provided the following comparison chart to enable you to choose the most suitable voice banking service that meets your needs. Other services may be available.
This pdf put together by the MND organisation lists and compares 3 organisations. We do not endorse or recommend any specific voice banking service and we recommend discussing voice banking and communication needs with your speech and language therapist at the earliest opportunity. If you do not yet have a speech and language therapist, ask to be referred by your GP, neurologist
Summary of main techniques for acquired apraxia of speech
Phonetic placement (Austermann etal.,2010, Ballard et al., 2007)
Sound production treatment (Wambaugh etal.,2012)
Repeated practice(Wambaughetal.,2012)
Speech Motor Learning Program (vanderMerweetal.,2007,2011)
Anodic tDCS stimulation + speech practice (Marangoloetal.,2011)
8-step continuum (Schneider&Frens, 2005)
8-step continuum +/- music therapy • Imaginedproduction; implicit phoneme manipulation (Cowelletal., 2010, Whiteside et al., 2012)
Phonomotor rehabilitation (Kendalletal.,2006)
Motor learning guided approach (Friedmanetal.,2010,Laskeretal.,2008, 2010)
Verbal and gestural training (Roseetal.,2006)
Visual feedback using electromagnetic articulography (Katzetal., 2010, McNeil et al., 2010)
Script training (Youmans etal., 2011a,b)
Apps
These resources have been chosen primarily for adults with acquired apraxia of speech, primary progressive apraxia of speech, and aphasia. Many focus on improving speech production, language, and communication through structured home practice.
Free Online Aphasia Therapy
Free online therapy activities to practise speaking, reading, writing and language skills. Particularly useful for independent home practice alongside speech and language therapy.
Aphasia Software Finder – Research and Evidence
https://www.aphasiasoftwarefinder.org/research-and-evidence
Summarises the research evidence supporting a wide range of aphasia therapy software, helping clinicians and families choose evidence-based digital resources.
Cuespeak
A personalised online aphasia therapy platform providing structured therapy activities that can be completed independently or alongside therapist support.
Please note: Aphasia and apraxia of speech frequently occur together following stroke or other neurological conditions. Many aphasia therapy resources can therefore also be valuable for individuals with acquired apraxia of speech.
Other support or techniques
Other support or techniques
Other support or techniques
Prosodic (rhythmic pacing)
Alternative/augmentative communication
Multi-modal training(e.g.,gesture+verbal)
Multiple Input Phoneme Therapy (MIPT)
The approach
Understanding Severe Apraxia of Speech and Verbal Motor Loops
Understanding Severe Apraxia of Speech and Verbal Motor Loops
An evidence-based approach designed for patients with severe apraxia of speech who are caught in verbal motor loops, helping them create new neural pathways for effective communication.
Understanding Severe Apraxia of Speech and Verbal Motor Loops
Understanding Severe Apraxia of Speech and Verbal Motor Loops
Understanding Severe Apraxia of Speech and Verbal Motor Loops
Severe apraxia of speech often traps patients in frustrating verbal motor loops where they produce stereotypic utterances—repetitive, invariant phrases that aren't contextually appropriate. These patients typically have limited functional vocabulary and minimal phrase production ability.
Neuroplasticity Foundations
Understanding Severe Apraxia of Speech and Verbal Motor Loops
Neuroplasticity Foundations
MIPT harnesses the brain's neuroplasticity to create new neural pathways for speech production. By systematically using existing stereotypic utterances as a foundation, therapists help patients build bridges to new, functional speech patterns.
Neural Pathway Creation
Neural Pathway Creation
Neuroplasticity Foundations
This approach recognizes that even damaged brains can form new connections when presented with consistent, structured sensory input across multiple modalities
Treatment steps
Neural Pathway Creation
Treatment steps
1. Record and model the client's speech, providing gestural and prosodic cues.
2. Fade Cues
3. Introduce New Targets
4. Increase complexity
The evidence
Neural Pathway Creation
Treatment steps
Stevens and Glaser (1983) conducted a cohort study (N=5) with stroke patients aged 49-73, demonstrating significant gains in verbal expression and reduction of perseverative utterances at the single word level. Current evidence suggests MIPT is particularly valuable for patients who have not responded to traditional apraxia treatments.
8 Step Continuum Treatment
Overview of the 8-Step Continuum
Originally Designed for Severe Speech Apraxia
Originally Designed for Severe Speech Apraxia
The 8-Step Continuum is an articulatory kinematic approach for apraxia of speech. It emphasizes improving the timing and placement of speech movements using modeling, positioning, and repetition. Integral stimulation—where patients observe the clinician’s face during speech—is central to the method, engaging visual, auditory, and motor pathways to support speech production.
Originally Designed for Severe Speech Apraxia
Originally Designed for Severe Speech Apraxia
Originally Designed for Severe Speech Apraxia
This method was initially created for individuals with severe apraxia of speech. It offers a structured and intensive framework to rebuild speech abilities, especially when comprehensive intervention is needed to establish consistent sound production and improve intelligibility in profoundly affected individuals.
Adaptability for Milder Case
Originally Designed for Severe Speech Apraxia
Adaptability for Milder Case
Although designed for severe apraxia, the 8-Step Continuum is flexible. Specific steps can be selectively applied to treat milder cases, helping clinicians tailor therapy based on a patient’s unique needs, speech challenges, and progression without overwhelming them with the full protocol.
The 8 Steps of the Continuum
Further Validation and Clinical Use
Adaptability for Milder Case
The steps include (1) clinician and patient say word together, (2) patient says word while clinician mouths it, (3) patient imitates modeled word, (4) independent repetition, (5) saying a written word, (6) saying word from visual memory, (7) saying word in response to a prompt, (8) using word in natural conversation or role-play.
Evidence from Initial Studies
Further Validation and Clinical Use
Further Validation and Clinical Use
Rosenbek et al. (1973) showed improved articulation and sequencing in three individuals with severe apraxia using this method. These early results highlighted the potential of structured, multisensory cueing in restoring speech function for patients with profound speech-motor planning deficits.
Further Validation and Clinical Use
Further Validation and Clinical Use
Further Validation and Clinical Use
Deal and Florance (1978) validated the approach with four additional severe apraxia cases. Their work supported its clinical effectiveness and demonstrated that it could be adapted for use in home programs, increasing accessibility and reinforcing therapy through caregiver-led practice outside clinical settings.
Speech motor learning treatment
Overview of Speech Motor Learning Treatment
This approach systematically trains consonant and vowel production. It begins with simple nonwords and progresses to functional speech. Designed for individuals with childhood apraxia of speech (CAS) or acquired apraxia of speech (AOS), it addresses challenges in speech motor planning across varied phonetic contexts and longer utterances.
Initial assessment rates production ease of speech sounds. Based on this, 3–4 consonants and 3–5 vowels are selected. As speech improves, more difficult sounds are gradually added in stages, usually expanding consonants first, followed by vowels.
Professor Van de Merwe writes a guest contribution
Professor Van de Merwe writes for Speech Apraxia UK-The SML Program was designed to guide the individual in re-/acquiring these components of speech motor planning. The treatment stimuli of the SML program address this aim and software that generates stimuli can be downloaded from www.apraxia-anitavandermerwe.co.za. The treatment starts with a small number of vowels and consonants that the speaker finds easy to produce and are combined in nonwords arranged in series. Real words containing these sounds are also introduced from the start of treatment. Across time more sounds are incorporated. In addition to clinical evidence, two experimental studies showed positive effects in both a child with CAS and an adult with AOS (Van der Merwe, 2011; 2018).
Research Gate
https://www.researchgate.net/profile/Anita_Merwe/contributions
ORCID ID
Treatment and Clinical Findings
Treatment and Clinical Findings
Treatment and Clinical Findings
Treatment begins with consonant-vowel-consonant-vowel (CVCV) nonwords (e.g., “paba”) using the easiest sounds. It then progresses to CVC words (e.g., “pam”), then longer nonwords (e.g., “patikam”), before introducing functional real words and phrases. Each level builds articulatory complexity systematically.
Research by Van der Merwe (2011, 2018) supports the approach for both AOS and CAS. While surface gains in sound production are common, true improvements target underlying motor planning, supporting automatic speech use and long-term generalization beyond therapy.
Strengths and Limitations
Treatment and Clinical Findings
Treatment and Clinical Findings
Strengths:
- Structured complexity progression
- Individualized starting points
- Validated for adults and children
- Direct focus on motor planning deficits
Limitations:
- Unclear link to participation and real-life communication
- More research needed on quality-of-life impact and functional gains
Script Training
What is script training
Who Benefits from Script Training?
Who Benefits from Script Training?
Script training is an evidence-based intervention used to improve functional communication for individuals with aphasia and apraxia of speech. The client and SLT work together to create personalized scripts based on specific, meaningful interactions. These scripts are practiced repeatedly until memorized. Benefits include improved speech rate, sentence structure, and communicative confidence. The approach emphasizes real-world relevance, helping clients communicate more effectively in predictable, everyday situations that matter to them.
Who Benefits from Script Training?
Who Benefits from Script Training?
Who Benefits from Script Training?
Script training supports diverse client needs. For those with fluent aphasia, it provides structured language templates. For non-fluent aphasia, it offers repetitive, predictable phrases to reinforce speech. Individuals with apraxia of speech benefit through focused motor speech pattern practice. This method is especially effective for clients with defined communication goals, such as ordering food or greeting coworkers, where mastering specific phrases has a tangible, positive impact on daily interactions.
The Script Training Process
Who Benefits from Script Training?
The Script Training Process
Script training follows a structured but personalized format:
- Identify a functional need—a situation meaningful to the client.
- Create a script collaboratively therapist and client build natural, tailored dialogue.
- Engage in repeated practice—client memorizes the script with support.
- Implement in real life—client uses the script in actual settings, reinforcing confidence and effectiveness. The collaborative nature makes it empowering, helping clients take ownership of their speech improvement journey.
Supporting Research
Considerations and Limitations
The Script Training Process
Youmans et al. (2011) evaluated script training in three individuals with apraxia of speech. All participants successfully memorized their scripts, and two improved their speech rate. Most impressively, script retention was observed six months after treatment, demonstrating lasting effects. These results support script training as a viable intervention for enhancing long-term functional communication skills, especially when focused on relevant, practiced dialogues that transfer effectively to real-world use.
Strengths of Script Training
Considerations and Limitations
Considerations and Limitations
Script training is highly resource-efficient, requiring minimal equipment and enabling focused home practice. It enhances functional communication by building familiarity with real-life interactions, encourages participation, and boosts confidence in social scenarios. The collaborative process fosters engagement and ownership. As scripts are based on the client’s needs and interests, motivation is often high, and progress is both measurable and meaningful in day-to-day life.
Considerations and Limitations
Considerations and Limitations
Considerations and Limitations
Despite its strengths, script training has limitations. It’s best suited to predictable, routine interactions and may not generalize to more spontaneous conversations. Success depends on motivation and practice, which can vary among clients. It is not a comprehensive solution for all communication challenges but rather a targeted strategy to address specific goals. Integrating script training with broader therapy approaches often yields the best functional outcomes.
Pacing Therapy
What is pacing
Pacing Boards Explained
Benefits of Pacing
Pacing is a technique that breaks words or syllables into smaller, manageable parts to slow speech and improve clarity. By separating sounds that may otherwise blur together, it helps individuals speak more clearly and deliberately. Pacing is especially beneficial for people with apraxia of speech, stuttering, or aphasia with motor speech issues. It supports better intelligibility and enhances communication by making speech easier for both the speaker and the listener.
Benefits of Pacing
Pacing Boards Explained
Benefits of Pacing
Pacing slows down speech, reducing the impact of rushed or blurred articulation. It encourages more deliberate speech, improves intelligibility, and helps reduce listener confusion. Pacing also supports breath control and promotes self-awareness during speaking. By improving speech clarity, it allows for better participation in conversations. It is particularly effective for motor speech disorders, offering a structured way to manage and monitor speech production without relying on complex tools or technology.
Pacing Boards Explained
Pacing Boards Explained
Step-by-Step: Using a Pacing Board
Pacing boards are simple visual tools with dots or circles arranged on a plain background. Each dot represents a syllable or speech segment. The user points to each dot while speaking, helping break words into clear parts. SLTs model the technique, then the client practices by pointing as they say each syllable. This method builds independence, self-monitoring, and clarity, using familiar words or phrases to reinforce success and make speech feel more natural.
Step-by-Step: Using a Pacing Board
Step-by-Step: Using a Pacing Board
Step-by-Step: Using a Pacing Board
Model: SLT points to each dot while saying a word slowly.
Practice: The client repeats, pointing to each dot per syllable.
Apply: Use agreed everyday words or phrases during practice.
Progress: Encourage independent use and generalization.
This structured approach helps the speaker monitor and control their rate, promoting clearer speech and gradual mastery of pacing techniques for daily communication situations.
Traditional and Tech based tools
Step-by-Step: Using a Pacing Board
Traditional and Tech based tools
Pacing can be implemented using traditional paper-based boards or digital apps. Modern pacing apps often include features like audio feedback or animations to support speech rhythm. Both approaches reinforce consistency, aid clarity, and can be tailored to suit client preferences and goals. Whether using low-tech or high-tech options, pacing tools offer flexible support and can be easily integrated with other speech therapy interventions for optimal results.
Research evidence
Step-by-Step: Using a Pacing Board
Traditional and Tech based tools
Studies comparing Sound Production Treatment (SPT) and Metrical Pacing Therapy (MPT) found that most participants benefited from both approaches, with slightly greater improvements in SPT. Benefits included better speech intelligibility, reduced fatigue, increased participation, and enhanced prosody. Pacing also helps lower cognitive load during speech and promotes self-monitoring. It’s a low-cost, effective intervention that supports long-term speech development and can complement other therapies to meet diverse communication needs.
Next month- SLPFlow
Product Review
Read our independent product reviews.
Product reviews- want your product reviewed? email info@spee
SLPflow
User Interface & Accessibility
· Clean, minimal interface focused on speed and clarity rather than visuals.
· Very short learning curve: add a patient, press record, run the session.
· Screen layout is simple and uncluttered, making it easy to use during live therapy.
· Web-based platform; no need for high-spec devices or specialist hardware.
· Designed for clinicians, not clients, this is a back-end tool, not a therapy app.
· It is ideal for speech and language professionals
Clinical Function & Structure
· Built around an AI Scribe that records sessions in the background and converts them into structured clinical documentation.
· Automatically generates:
session overviews
SOAP-style or other SLT style progress notes
full written session transcripts
· Sessions are clearly segmented, making it easy to review what happened and when.
· Particularly helpful for long sessions (e.g. 45–60 minutes), where manual note-taking is time-consuming.
Automation & AI Features
· AI-powered progress notes are generated almost instantly once recording stops.
· Automated cue detection tags clinical cues used during the session, which can then be reviewed and edited.
· Patient goal tracking runs across every session, allowing progress to be monitored continuously.
· Goals are entered one per line, which works well for tracking and reporting.
· Outputs can be used to quickly populate reports such as IEPs.
Customization & Clinical Control
· Patient setup includes:
full name
age (in years)
condition notes
therapy goals (optional)
· Clinicians retain full control: AI notes must be reviewed and edited.
· Works best when supplemented with brief clinician-written notes to correct nuance or context.
· Not prescriptive, SLPFlow does not dictate assessment frameworks or therapy approaches.
Feedback, Accuracy & Limitations
· Transcription quality is strong, but not perfect.
· Occasional inaccuracies appear in summaries or SOAP notes, requiring clinician review.
· There is no audio playback, you cannot listen back to the session recording; only the written transcript is available.
· The system does not analyse speech accuracy or clinical effectiveness; it documents what occurred.
· You could not use the system to transcribe speech sound analysis.
Data Handling & Workflow Efficiency
· Uploads recordings quickly (usually a few seconds).
· Notes are stored in an organised, session-by-session format.
· Significantly reduces end-of-day paperwork and report-writing time.
· Particularly useful for private practice clinicians balancing high caseloads.
Evidence-Informed Use
· SLPFlow is clinically neutral: it supports documentation, not diagnosis or therapy decision-making.
· Effective use depends entirely on clinician skill and judgement.
· Appropriate for complex populations (including speech apraxia) only when paired with strong clinical reasoning.
· Not a substitute for dynamic assessment or motor learning principles.
Value & Cost
· $20/month
· 14-day free trial
· Low cost compared to the amount of clinician time saved.
· No tiered complexity, pricing is transparent and accessible.
Summary Recommendation
SLPFlow is a practical, efficient documentation and workflow tool that does exactly what it claims: it reduces paperwork so clinicians can focus on care. The AI Scribe is fast, intuitive, and genuinely useful, provided clinicians understand its limitations and take responsibility for reviewing and editing notes.
It is not a therapy app or a diagnostic tool, and not a replacement for clinical thinking. However, it does bring up AI suggestions for interpretation of session results. Used thoughtfully, it is an effective and affordable solution for busy SLTs who want accurate, structured notes without spending hours writing them. I thought it was excellent and it is like having a therapy friend. For speech apraxia, clinicians often have to transcribe speech which this will not do. However, it will collect notes for the rest of the session making it an essential tool.
(Speechapraxia.co.uk reviewed SLPFlow after approximately six months of clinical use. The software was not used as a diagnostic tool. See www.slpflow.com for further details.)
Cuespeak
User Interface & Accessibility
- Simple home screen with access to settings and user memory, reports.
- Intuitive touchscreen interface, accessible for individuals with communication difficulties.
- Particularly useful props for in-session communication, though the “feelings” tool does not track emotions over time (a missed opportunity).
- Runs on iPad, iPhone, and Apple Silicon Macs. Requires iOS 15 or higher.
Therapeutic Content & Structure
- One of the most extensive therapy libraries available on products reviewed (14+ modules).
- Covers: word and phrase production, sentence construction, understanding spoken/written language, reading and writing, question/answering, verbs, personal/family vocabulary, sounds and structure, and non-verbal reasoning.
- Each module has multiple exercise sets (e.g., verbs module includes 11 sets).
- Tasks are offered at easy, medium, or hard levels, with clear tutorials and “Tips” functions for each activity.
- Stays current with news-based questions and real-life conversational contexts, making it highly relevant for adults.
- It has some useful communication tools (e.g., map, notepad, numbers, time, days/months, feelings, and record-and-hear).
Customization & Adaptability
- Exercises can be configured to any level of difficulty, from occasional word-finding difficulties to severe expressive/receptive impairments.
- Option to create personalised content using therapy templates (family names, friends, pets, meaningful places, personal scenarios).
- If a word is missing from the database, users can request its addition.
- Thousands of videos are available (over 15,000) with syllable-level modelling and playback.
Feedback & Progress Tracking
- Users can record and review their own speech attempts and compare with video models.
- Session reports are generated and can be shared with therapists, friends, or family members.
- Sharing enables therapists to remotely configure and monitor therapy.
- While self-comparison is strong, there is no automated speech accuracy scoring.
Data Sharing & Collaboration
- Therapy sessions and results can be shared online, supporting remote therapy and collaboration.
- Family Sharing is supported (subscription can be shared across devices with the same Apple ID).
- Organization licensing is available with different pricing structures.
User Engagement & Motivation
- Keeps therapy relevant with up-to-date news discussions and everyday scenarios.
- Wide variety of modules and exercises reduces the risk of therapy fatigue.
- Supports independent practice or therapist-led sessions.
Technical Performance
- Generally smooth performance, though app updates each time it is opened, which can delay access slightly.
- Rated 4.6/5 on the App Store (263 ratings).
- App size: 125 MB.
Evidence-Informed Design
- Developed by specialist SLTs.
- Informed by up-to-date research into speech and language therapy.
- Strong focus on aphasia and word-finding therapy; less directly tailored to apraxia of speech, though speech recording and playback features may still be useful.
Value & Cost
- Subscription model:
- £9.99/month (auto-renewing).
- £132.99/year (non-renewing).
- £399.99/3 years (non-renewing).
- The 14-day free trial includes full content access.
- Family sharing is enabled for home users.
- Higher cost compared to one-off purchase apps, but reflects extensive and continually updated content.
Summary Recommendation
Cuespeak is an exceptionally comprehensive and adaptable therapy app, particularly well-suited for adults with aphasia and word-finding difficulties. Its vast library, real-life relevance, and ability to personalise therapy make it a powerful tool for both independent users and SLT-led practice. While less targeted at apraxia of speech than some alternatives, its recording, playback, and flexible customisation options can still support individuals with motor speech difficulties.
The subscription model makes it a more expensive option compared to one-off apps, but for users needing varied, personalised, and regularly updated therapy content, it offers significant value.
(Speechapraxia.co.uk reviewed Cuespeak in August 2025. The app was provided free of charge for review purposes. See www.cuespeak.com for further details.)
Choosing a therapy
Which therapy is right?
The therapies listed here are all used to support individuals with speech apraxia. Therapists may sometimes use a combination of approaches.