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What Is 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. Milder forms of apraxia are known as dyspraxia.
Apraxia can
occur in a number of different forms. One form is orofacial apraxia. People
with orofacial apraxia are unable to voluntarily perform certain movements
involving facial muscles. For instance, they may not be able to lick their lips
or wink. Another form of apraxia affects a person's ability to intentionally
move arms and legs.
With apraxia
of speech a person finds it difficult or impossible to move his or her mouth and tongue to
speak. This happens, even though the person has the desire to speak and the mouth and
tongue muscles are physically able to form words.
There are
two forms of apraxia of speech -- acquired apraxia and developmental apraxia.
Acquired apraxia can occur in people of all ages. Typically, though, it is
found in adults. This condition causes people to lose the speech-making
abilities they once possessed.
Developmental
apraxia of speech is also known as childhood apraxia of speech. This condition
is present from birth, and it affects a child's ability to form sounds and words.
Children with speech apraxia often have far greater abilities to understand
speech than to express themselves with spoken words.
The majority
of children with developmental apraxia will experience significant improvement,
if not complete recovery, with the correct treatment.
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 might both have difficulty expressing themselves with
words. There are, though, distinct differences between the two. Aphasia
describes a problem in a person's ability to understand or use words in and of
themselves. This may make it hard for someone with the condition to speak,
read, or write. But apraxia does not describe a problem with language
comprehension. Apraxia refers to the difficulty someone has initiating and
performing the movements needed to make speech. This difficulty arises despite
the fact that there is no weakness in
the necessary muscles.
What Are the Symptoms of Apraxia of
Speech?
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
What
Causes Apraxia of Speech?
Acquired
apraxia results from brain
damage to those areas of the brainthat 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 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.
Are There Tests to Diagnose Apraxia
of Speech? continued...
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.
Are There Treatments for Apraxia of
Speech?
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.
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