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What is Apraxia?

Meaning and Definition of Apraxia

Apraxia is a poorly understood neurological condition. People who have it find it difficult or impossible to make certain motor movements, even though their muscles are normal. The milder forms of are known as dyspraxia.

It can occur in several different forms. One way is the orofacial. People with orofacial are unable to voluntarily perform certain movements that involve the facial muscles. For example, they may not be able to lick their lips or wink. Another form affects a person’s ability to intentionally move arms and legs.

With apraxia of speech, a person finds it difficult or impossible to move their mouth and tongue to speak. This happens even though the person has the desire to speak and the muscles of the mouth and tongue are physically capable of forming words.

Are there different types of apraxia of speech?

There are two forms of apraxia of speech: acquired and childhood speech apraxia. Acquired can occur in people of all ages. Usually, however, it is found in adults. This condition causes people to lose the speaking skills they once possessed.

Childhood apraxia of speech is a motor speech disorder. This condition is present from birth and affects the child’s ability to form sounds and words. Children with often have much greater abilities to understand speech than to express themselves in spoken words.

Most children with childhood apraxia of speech will experience significant improvement, if not complete recovery, with the correct treatment.

Difference Between Apraxia of Speech and Aphasia

Apraxia is sometimes confused with aphasia, another communication disorder. That confusion can be complicated by the fact that the two conditions can occur together.

People with apraxia and aphasia may have difficulty expressing themselves with words. However, there are clear differences between the two. Aphasia describes a problem in a person’s ability to understand or use words themselves. This can make it difficult for someone with the condition to speak, read, or write. But apraxia does not describe a problem with understanding language.

Apraxia refers to the difficulty someone has in initiating and making the movements necessary to speak. This difficulty arises despite the fact that there is no weakness in the necessary muscles.

Symptoms

There are a variety of speech-related symptoms that can be associated with apraxia, including:

  • Difficulty or inability to put syllables together in the proper order to form words
  • Minimal babbling during infancy
  • Difficulty saying long or complex words.
  • Repeated attempts to pronounce words
  • Speech inconsistencies, such as being able to say a sound or word correctly at certain times but not at others
  • Incorrect inflections or stresses on certain sounds or words
  • Excessive use of non-verbal forms of communication.
  • Distort vowel sounds.
  • Skip consonants at the beginning and end of words.
  • Seeming to grope or struggle to make words

Childhood apraxia of speech rarely occurs alone. It is often accompanied by other language or cognitive deficits, which can cause:

  • limited vocabulary
  • grammar problems
  • Coordination and fine motor problems.
  • Difficulty chewing and swallowing
  • Clumsiness

What causes apraxia of speech?

Acquired apraxia results from brain damage to those areas of the brain that control the ability to speak. Conditions that can produce acquired apraxia include head trauma, stroke, or a brain tumor.

Experts still don’t understand what causes childhood apraxia of speech. Some scientists believe it is the result of signaling problems between the brain and the muscles used for speaking.

Ongoing research is focused on whether the brain abnormalities that cause apraxia of speech can be identified. Other research is looking for genetic causes of apraxia. Some studies are trying to determine exactly which parts of the brain are linked to the condition.

Diagnosis

There is no single test or procedure used to diagnose childhood apraxia of speech. Diagnosis is complicated by the fact that speech-language pathologists have different opinions about what symptoms indicate the condition.

However, most experts look for the presence of multiple common symptoms of apraxia. They can assess the patient’s ability to repeat a word multiple times. Or they can test whether a person can recite a list of words that are increasingly difficult, such as “play, play, play.”

A speech-language pathologist may interact with a child to assess what sounds, syllables, and words the child can make and understand. The pathologist will also examine the child’s mouth, tongue, and face for structural problems that may be causing symptoms of apraxia.

When diagnosing apraxia, experts may look for other symptoms. For example, they may look for weakness or difficulties with understanding language. Both are indicative of other conditions and their presence would help rule out apraxia. For people with possible acquired apraxia, an MRI of the brain may be helpful in determining the extent and location of any brain damage.

A diagnosis of childhood apraxia of speech usually cannot be made before a child’s second birthday. Before this time, most children cannot understand or perform the tasks necessary to determine the presence of apraxia.

Treatments

In some cases of acquired apraxia, the condition resolves spontaneously. This is not the case with childhood apraxia of speech, which does not go away without treatment.

There are several treatment approaches used for apraxia. How effective they are can vary from person to person. For best results, apraxia treatment should be developed to meet the needs of a given individual.

Most children with apraxia of speech benefit from meeting one-on-one with a speech-language pathologist three to five times a week. They may also need to work with their parents or guardians to practice the skills they are developing.

Therapy for childhood apraxia of speech aims to improve speech coordination. Exercises may include:

  • Repeatedly practice the formation and pronunciation of sounds and words.
  • Practicing chaining sounds to pronounce
  • Working with rhythms or melodies
  • Using multisensory approaches, such as looking in a mirror while trying to form words or touching the face while speaking

Many therapists believe that sign language is beneficial for children who have difficulty being understood. They often recommend that children try to say the words they are signing to practice making the necessary movements with their mouths.

People with more extreme cases of acquired apraxia may also benefit from sign language. Or they may use electronic assistive devices, including computers that can be used to produce words and sentences.

Very few studies have been conducted to determine the relative effectiveness of various treatment approaches for childhood apraxia of speech. This may be due, in part, to the ongoing debate among experts about what symptoms and features warrant a diagnosis of apraxia.

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