How does AOS typically affect intelligibility across reading, repetition, and spontaneous speech?

• A. Spontaneous speech is usually more impaired; repetition and reading can be relatively better with cues and practice.
• B. Reading is always the most impaired modality.
• C. Repetition is universally the least intelligible modality.
• D. Intelligibility is the same across all modalities.

Answer: (C)

In apraxia of speech, the core difficulty is planning and programming the precise movements for speech. Spontaneous speech requires you to generate entirely new motor sequences on the fly, which puts the greatest demand on motor planning and often leads to more impaired intelligibility. Repetition and reading, on the other hand, give you a ready-made motor template or external guidance: repetition relies on practiced sequences you can reproduce, and reading provides orthographic cues that help map letters to sounds. With those supports, the motor plan can be more reliably executed, so intelligibility tends to be better in reading and repetition, especially when cues or practice help. Of course, there’s individual variability, and some patients may show different patterns, but the typical trend is that spontaneous speech is most impaired and reading/repetition are comparatively better.