What Is Apraxia: Symptoms, Causes, And Treatments

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What Is Apraxia?

Apraxia is an engine issue caused by harm to the cerebrum (particularly the back parietal cortex). In which the individual experiences issues with the engine wanting to perform undertakings or developments when asked, gave that the demand or order is comprehended and he/she will play out the assignment. The idea of the cerebrum harm decides the seriousness, and the nonappearance of tangible misfortune or loss of motion clarifies the level of trouble.

To talk, messages must go from your cerebrum to your mouth. These messages advise the muscles how and when to move to make sounds. When you have apraxia of discourse, the messages don’t overcome effectively, because of cerebrum harm. You won’t not have the capacity to move your lips or tongue the correct method to state sounds. At times, you won’t not have the capacity to talk by any means.

Apraxia of discourse is infrequently called gained apraxia of discourse, verbal apraxia, or dyspraxia. It is an engine discourse issue. You can likewise have apraxia in different parts of your body, as in your arms or legs. This is called appendage apraxia.

How serious your apraxia is relies upon what sort of cerebrum harm you have. Apraxia can occur in the meantime as other discourse or dialect issues. You may have muscle shortcoming in your mouth. This is called dysarthria. You could likewise experience difficulty understanding what others say or telling others what you are considering. This is called aphasia.

Youngsters can likewise have apraxia. This is called youth apraxia of discourse.

Apraxia is an inadequately comprehended neurological condition. Individuals who have it think that its troublesome or difficult to make certain engine developments, despite the fact that their muscles are typical. Milder types of apraxia are known as dyspraxia.

Apraxia can happen in various diverse structures. One shape is orofacial apraxia. Individuals with orofacial apraxia can’t willfully play out specific developments including facial muscles. For example, they will be unable to lick their lips or wink. Another type of apraxia influences a man’s capacity to purposefully move arms and legs.

With apraxia of discourse a man thinks that its troublesome or difficult to move his or her mouth and tongue to talk. This happens, despite the fact that the individual wants to talk and the mouth and tongue muscles are physically ready to frame words.

Apraxia of discourse (AOS)— otherwise called procured apraxia of discourse, verbal apraxia, or youth apraxia of discourse (CAS) when analyzed in kids—is a discourse sound issue. Somebody with AOS experiences difficulty saying what he or she needs to state effectively and reliably. AOS is a neurological issue that influences the cerebrum pathways associated with arranging the succession of developments engaged with delivering discourse. The cerebrum comprehends what it needs to state, however can’t appropriately plan and arrangement the required discourse sound developments.

AOS isn’t caused by shortcoming or loss of motion of the discourse muscles (the muscles of the jaw, tongue, or lips). Shortcoming or loss of motion of the discourse muscles brings about a different discourse issue, known as dysarthria. A few people have both dysarthria and AOS, which can make determination of the two conditions more troublesome.

The seriousness of AOS changes from individual to individual. It can be mild to the point that it causes issue with just a couple of discourse sounds or with articulation of words that have numerous syllables. In the most serious cases, somebody with AOS won’t not have the capacity to impart successfully by talking, and may require the assistance of elective specialized strategies.

Causes

Apraxia is most often due to a lesion located in the dominant (usually left) hemisphere of the brain, typically in the frontal and parietal lobes. Lesions may be due to stroke, acquired brain injuries, or neurodegenerative diseases such as Alzheimer’s disease or other dementias, Parkinson’s disease, or Huntington’s disease. It is also possible for apraxia to be caused by lesions in other areas of the brain including the non-dominant (usually right) hemisphere.

Ideomotor apraxia is typically due to a decrease in blood flow to the dominant hemisphere of the brain and particularly the parietal and premotor areas. It is frequently seen in patients with corticobasal degeneration.

Ideational apraxia has been observed in patients with lesions in the dominant hemisphere near areas associated with aphasia; however, more research is needed on ideational apraxia due to brain lesions. The localization of lesions in areas of the frontal and temporal lobes would provide explanation for the difficulty in motor planning seen in ideational apraxia as well as its difficulty to distinguish it from certain aphasias.

Constructional apraxia is often caused by lesions of the inferior non-dominant parietal lobe, and can be caused by brain injury, illness, tumor or other condition that can result in a brain lesion.

CAS is a motor speech disorder. Something in your child’s brain does not allow messages to get to his mouth. Most of the time, the cause is unknown. It is possible that nothing would show up if you had tests done, like an MRI or CT scan of your child’s brain. This can be frustrating as you look for a reason for your child’s speech problems.

In some cases, your child may have brain damage that causes CAS. Your child may have a genetic disorder or syndrome that causes brain damage. A stroke or brain injury can also cause CAS.

Damage to the parts of the brain that control how your muscles move causes apraxia of speech. Any type of brain damage can cause apraxia. This includes stroke, traumatic brain injury, dementia, brain tumors, and brain diseases that get worse over time.

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

Experts do not yet understand what causes childhood apraxia of speech. Some scientists believe that it results from signaling problems between the brain and the muscles used for speaking.

Ongoing research is focusing on whether 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.

There are two main types of AOS: acquired apraxia of speech and childhood apraxia of speech.

Acquired AOS can affect someone at any age, although it most typically occurs in adults. Acquired AOS is caused by damage to the parts of the brain that are involved in speaking and involves the loss or impairment of existing speech abilities. It may result from a stroke, head injury, tumor, or other illness affecting the brain. Acquired AOS may occur together with other conditions that are caused by damage to the nervous system. One of these is dysarthria, as mentioned earlier. Another is aphasia, which is a language disorder. (For more information, see the NIDCD fact sheet Aphasia.)

Childhood AOS is present from birth. This condition is also known as developmental apraxia of speech, developmental verbal apraxia, or articulatory apraxia. Childhood AOS is not the same as developmental delays in speech, in which a child follows the typical path of speech development but does so more slowly than is typical. The causes of childhood AOS are not well understood. Imaging and other studies have not been able to find evidence of brain damage or differences in the brain structure of children with AOS. Children with AOS often have family members who have a history of a communication disorder or a learning disability. This observation and recent research findings suggest that genetic factors may play a role in the disorder. Childhood AOS appears to affect more boys than girls.

Symptoms

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

  • Difficulty stringing syllables together in the appropriate order to make words, or inability to do so
  • Minimal babbling during infancy
  • Difficulty saying long or complex words
  • Repeated attempts at pronunciation of words
  • Speech inconsistencies, such as being able to say a sound or word properly at certain times but not others
  • Incorrect inflections or stresses on certain sounds or words
  • Excessive use of nonverbal forms of communication
  • Distorting of vowel sounds
  • Omitting consonants at the beginnings and ends 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 may cause:

  • Limited vocabulary
  • Grammatical problems
  • Problems with coordination and fine motor skills
  • Difficulties chewing and swallowing
  • Clumsiness

Diagnosis

Although qualitative and quantitative studies exist, there is little consensus on the proper method to assess for apraxia. The criticisms of past methods include failure to meet standard psychometric properties as well as research-specific designs that translate poorly to non-research use.

The Test to Measure Upper Limb Apraxia (TULIA) is one method of determining upper limb apraxia through the qualitative and quantitative assessment of gesture production. In contrast to previous publications on apraxic assessment, the reliability and validity of TULIA was thoroughly investigated. The TULIA consists of subtests for the imitation and pantomime of non-symbolic (“put your index finger on top of your nose”), intransitive (“wave goodbye”) and transitive (“show me how to use a hammer”) gestures. Discrimination (differentiating between well- and poorly performed tasks) and recognition (indicating which object corresponds to a pantomimed gesture) tasks are also often tested for a full apraxia evaluation.

However, there may not be a strong correlation between formal test results and actual performance in everyday functioning or activities of daily living (ADLs). A comprehensive assessment of apraxia should include formal testing, standardized measurements of ADLs, observation of daily routines, self-report questionnaires and targeted interviews with the patients and their relatives.

As stated above, apraxia should not be confused with aphasia; however, they frequently occur together. It has been stated that apraxia is so often accompanied by aphasia that many believe that if a person displays AOS; it should be assumed that the patient also has some level of aphasia.

There is not a single test or procedure that is used to diagnose apraxia of speech. Diagnosis is complicated by the fact that speech-language pathologists have different opinions about which symptoms indicate developmental apraxia.

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

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

When diagnosing apraxia, experts may look for the presence of other symptoms. For instance, they may look for weakness or difficulties with language comprehension. Both of these 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 useful to determine the extent and location of any brain damage.

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

Professionals known as speech-language pathologists play a key role in diagnosing and treating AOS. Because there is no single symptom or test that can be used to diagnose AOS, the person making the diagnosis generally looks for the presence of several of a group of symptoms, including those described earlier. Ruling out other conditions, such as muscle weakness or language production problems (e.g., aphasia), can help with the diagnostic process.

In formal testing for both acquired and childhood AOS, a speech-language pathologist may ask the patient to perform speech tasks such as repeating a particular word several times or repeating a list of words of increasing length (for example, love, loving, lovingly). For acquired AOS, a speech-language pathologist may also examine the patient’s ability to converse, read, write, and perform nonspeech movements. To diagnose childhood AOS, parents and professionals may need to observe a child’s speech over a period of time.

Treatment

Treatment for individuals with apraxia includes speech therapy, occupational therapy, and physical therapy. Generally, treatments for apraxia have received little attention for several reasons, including the tendency for the condition to resolve spontaneously in acute cases. Additionally, the very nature of the automatic-voluntary dissociation of motor abilities that defines apraxia means that patients may still be able to automatically perform activities if cued to do so in daily life. Nevertheless, research shows that patients experiencing apraxia have less functional independence in their daily lives,[and that evidence for the treatment of apraxia is scarce.

However, a literature review of apraxia treatment to date reveals that although the field is in its early stages of treatment design, certain aspects can be included to treat apraxia.

One method is through rehabilitative treatment, which has been found to positively impact apraxia, as well as activities of daily living. In this review, rehabilitative treatment consisted of 12 different contextual cues, which were used in order to teach patients how to produce the same gesture under different contextual situations. Additional studies have also recommended varying forms of gesture therapy, whereby the patient is instructed to make gestures (either using objects or symbolically meaningful and non-meaningful gestures) with progressively less cuing from the therapist. It may be necessary for patients with apraxia to use a form of alternative and augmentative communication depending on the severity of the disorder.

In addition to using gestures as mentioned, patients can also use communication boards or more sophisticated electronic devices if needed. No single type of therapy or approach has been proven as the best way to treat a patient with apraxia, since each patient’s case varies. However, one-on-one sessions usually work the best, with the support of family members and friends. Since everyone responds to therapy differently, some patients will make significant improvements, while others will make less progress.

The overall goal for treatment of apraxia is to treat the motor plans for speech, not treating at the phoneme (sound) level. Research suggests that individuals with apraxia of speech should receive treatment that focuses on the repetition of target words and rate of speech. Research rerouted that the overall goal for treatment of apraxia should be to improve speech intelligibility, rate of speech and articulation of targeted words.

The goal of treatment is to help your child say sounds, words, and sentences more clearly. Your child needs to learn how to plan the movements he needs to say sounds. Then he needs to learn how to make those movements the right way at the right time. Doing exercises to make his mouth muscles stronger will not help. His muscles are not weak if he has CAS. Working on how to move those muscles to say sounds will help.

Your child must practice speaking to get better at it. It helps to use all of her senses as she learns how to say sounds. She may use “touch” cues, like putting her finger on her lips when saying the “p” sound to remind her to close her lips. Or, she may use visual cues, like watching herself in a mirror. Hearing how she sounds on a recording can help, too. This sensory feedback can help your child repeat sounds and words and start using them in longer sentences.

The SLP can work with you to improve how you say sounds and put sounds into words. Treatment will focus on getting your muscles to move correctly. You may need to retrain your muscles to make sounds. Repeating sounds over and over and practicing correct mouth movements can help. You may need to slow down or pace your speech so that you can say the sounds you need to say. In severe cases, you may need to find other ways to answer questions or tell people what you want. These may include simple hand gestures, writing, pointing to letters or pictures, or using a computer. This is called augmentative and alternative communication.

It is important to get help if you have apraxia of speech. Talk to your doctor about seeing an SLP, or look for an SLP in your area by visiting ProFind.

See ASHA information for professionals on the Practice Portal’s Acquired Apraxia of Speech page.

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

There are various treatment approaches used for apraxia. How effective they are can vary from person to person. For the best results, apraxia treatment must be developed to meet a given individual’s needs. 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 practicing the formation and pronunciation of sounds and words
  • Practicing stringing together sounds to make speech
  • Working with rhythms or melodies
  • Using multisensory approaches, such as watching in a mirror while trying to form words or touching the face while talking

Many therapists believe that sign language is beneficial for children who have difficulty being understood. They often recommend that children attempt 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 assistive electronic devices, including computers that can be used to produce words and sentences.

Very few studies have been done to determine the relative effectiveness of various treatment approaches for childhood apraxia of speech. This may be due, in part, to ongoing debate among experts as to which symptoms and characteristics merit a diagnosis of apraxia.

In some cases, people with acquired AOS recover some or all of their speech abilities on their own. This is called spontaneous recovery.

Children with AOS will not outgrow the problem on their own. They also do not acquire the basics of speech just by being around other children, such as in a classroom. Therefore, speech-language therapy is necessary for children with AOS as well as for people with acquired AOS who do not spontaneously recover all of their speech abilities.

Speech-language pathologists use different approaches to treat AOS, and no single approach has been proven to be the most effective. Therapy is tailored to the individual and is designed to treat other speech or language problems that may occur together with AOS. Frequent, intensive, one-on-one speech-language therapy sessions are needed for both children and adults with AOS. (The repetitive exercises and personal attention needed to improve AOS are difficult to deliver in group therapy.) Children with severe AOS may need intensive speech-language therapy for years, in parallel with normal schooling, to obtain adequate speech abilities.

In severe cases, adults and children with AOS may need to find other ways to express themselves. These might include formal or informal sign language; a notebook with pictures or written words that can be pointed to and shown to other people; or an electronic communication device—such as a smartphone, tablet, or laptop computer—that can be used to write or produce speech. Such assistive communication methods can also help children with AOS learn to read and better understand spoken language by stimulating areas of the brain involved in language and literacy.

Some adults and children will make more progress during treatment than others. Support and encouragement from family members and friends and extra practice in the home environment are important.

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