Apraxia of speech (AOS) is a neurogenic motor speech disorder characterized by impaired planning and programming of speech articulation movements. According to the American Speech-Language-Hearing Association, prominent features of AOS include phonemic distortions, phonemic substitutions or additions, reduced overall speech rate, and prosodic abnormalities that may worsen with increased complexity. Some well-researched treatment approaches include a) rate-rhythm control techniques emphasizing prosodic elements of speech production; b) articulatory–kinematic practice emphasizing accurate articulatory movements administered in person or via telepractice; and c) advanced instrumentation such as ultrasound intra-oral imaging for visual feedback of the articulators during speech production.

DB is a right-handed college-educated monolingual English-speaking gentleman who incurred a left fronto-insular-parietal stroke at age 57 in 2017.  Initial assessment revealed severe AOS at the monosyllabic level. From 2017 to 2023, a series of treatment approaches (rate-rhythm control, articulatory–kinematic practice, and ultrasound intra-oral imaging) was administered, with pauses in 2019 and 2021 to manage co-morbid complications such as seizures, post-stroke nerve pain, and side-effects of anti-convulsant medications, as well as the barrier of COVID-19 pandemic-induced isolation.

Across all treatments, DB demonstrated substantial gains in motor-speech control and intelligibility of at least 75% or more accurate production of target phonemic sequences in words embedded in repeated sentences. The synergistic approach combining rate-rhythm control techniques with articulatory kinematic practice and ultrasound intra-oral imaging was particularly effective, with DB achieving 100% accurate production of sentences containing words with target phonemic sequences. The involvement of DB's wife during treatment sessions facilitated generalization of successful techniques to daily communicative activities.