Speech and Language

Boy eating from orange bowlIn typical speech and language development, a child’s receptive (understanding) and expressive (speaking) skills usually increase together. Many children with hemiplegia have a delay in expressive speech, yet their ability to understand language (receptive speech) is usually within the typical range.

Learn more about the treatment of speech and language delays, including Sign Language, Communication Devices, Speech Play, and more  in the Speech Therapy section of our website.



Aphasia is a language impairment that affects the production or comprehension of speech and the ability to read or write.  Children who have hemiplegia or have experienced a stroke may have aphasia due to their brain injury. The aphasia may be very mild or may be so severe that communication by the child is almost impossible.  Aphasia may affect the child’s expressive language, yet, the child may be able to understand the speech of other people.   Aphasia may co-occur with speech disorders such as dysarthria or apraxia of speech. Speech therapists work with children who have aphasia.


Apraxia of speech (verbal dyspraxia) is a speech disorder characterized by inability to speak, or a severe struggle to speak clearly.  Children with hemiplegia or hemiparesis may experience apraxia of speech.  Apraxia of speech occurs when the oral-motor muscles do not or cannot obey commands from the brain, or when the brain cannot reliably send these commands. Apraxia of speech is  characterized by highly inconsistent speech errors. Children with apraxia can be helped with intensive speech therapy. Parents of children with hemiplegia recommend that you choose a speech and language pathologist (therapist) who has experience in helping children who have apraxia.


Dysarthria is a neurological speech disorder caused by paralysis, weakness, improper muscle tone or incoordination of the muscles of the mouth.  Dysarthria is not a disorder of language. Children with hemiplegia or hemiparesis may experience dysarthria. Symptoms of dysarthria may include speech that is slurred, slow, and difficult to produce and/or understand. Individuals with dysarthria may also have problems controlling the pitch, loudness, rhythm and voice qualities of their speech.  Associated problems may include drooling and difficulty chewing and swallowing.  Unlike apraxia of speech, the speech errors that occur with dysarthria are highly consistent from one occasion to the next.

Meet Greyson – Speech Apraxia and How Sign Language Changed Our World

Boy sticking out tongueAuditory Processing Disorder

Auditory Processing Disorder – American Speech Language Hearing Association

Language and Pediatric Stroke

A tale of two hands: children’s early gesture use in narrative production predicts later narrative structure in speech

Vocabulary, syntax, and narrative development in typically developing children and children with early unilateral brain injury: early parental talk about the “there-and-then” matters

Narrative processing in typically developing children and children with early unilateral brain injury: seeing gesture matters

Narrative Skill in Children with Early Unilateral Brain Injury: A Possible Limit to Functional Plasticity

Later language development in narratives in children with perinatal stroke

Early Gesture Predicts Language Delay in Children With Pre- or Perinatal Brain Lesions

Communication in the Schools

Frequently Asked Questions on Effective Communication for Students with Hearing, Vision or Speech Disabilities in Public Elementary and Secondary Schools

Meeting the Communication Needs of Students with Hearing, Vision, or Speech Disabilities

Other Resources

American Speech-Language-Hearing Association

National Aphasia Association


The CHERAB Foundation