If a patient demonstrates relatively intact nonverbal oral movements but impaired speech tasks, what does this suggest?

• A. Global motor impairment
• B. Speech planning deficit with preserved non-speech motor control
• C. Pure limb apraxia
• D. Pure dysarthria

Answer: (B)

When nonverbal oral movements are relatively intact but speech tasks are impaired, the pattern points to a problem in planning and programming the speech movements rather than in the muscles or in execution. The ability to move the lips, tongue, and jaw for non-speech tasks shows the motor system for those actions is functioning, but arranging and coordinating those movements specifically for fluent, accurate speech is disrupted. This dissociation is characteristic of a speech planning deficit, i.e., apraxia of speech, where the sequencing and timing of articulatory gestures in connected speech are impaired despite preserved basic motor abilities.

This fits better than a global motor impairment, which would affect many motor activities beyond speech. It also contrasts with pure limb apraxia, which centers on planning for limb movements rather than oral movements. And it contrasts with pure dysarthria, where the problem is at the level of neuromuscular execution of speech; if non-speech oral movements are preserved, the evidence supports a planning rather than execution deficit.