What is Apraxia?
Apraxia is a neurological condition in which the affected person may not be able to perform a particular movement when they want to. This is true even when the movement is learned. In some cases, mild symptoms are seen and this condition is referred to as dyspraxia. There are different types of apraxia based on the part of the body affected. In orofacial apraxia, the affected person finds it hard to move facial muscles voluntarily. They are unable to wink or lick their lips even when they want to. In another type of this condition, the person may not be able to move their hands or legs. In speech apraxia, the person cannot move his or her tongue or mouth. This prevents them from framing words physically.
If a person who was previously able to perform the function develops apraxia, the condition is referred to as acquired apraxia. One of the most common causes of this condition is brain damage.
Damage to the cerebrum which affects the brain’s ability to plan any motor activities leads to apraxia. Aphasia is not the same as apraxia. Aphasia occurs when there is damage caused to the left hemisphere. It is a language disorder in which individual has difficulty in understanding or producing language. Apraxia can occur in conjunction with aphasia or dysarthria which is also known as weakness of muscles which ultimately affects the production of speech.
Other causes of apraxia include:
- Brain tumor
- Neurodegenerative diseases
- Dementia
- Stroke
- Brain injury
Apraxia seen at birth is known as developmental apraxia, and the cause of this condition is not clear.
The most common symptom of this condition is the inability to make the right muscle movement. With speech apraxia, a person may not be able to use the right word or action and often end up using the wrong action or word in place.
Other symptoms of speech apraxia include:
- Distorted and repeated words
- Incorrect order of the words
- Using non-verbal methods of communication
- Incorrect stress on certain words
- Distortion of vowels
- Struggling to use complex words
- Difficulty in pronouncing the right word
- Communicating better with writing than speaking
- During infancy there is minimum babbling
- Inconsistency in speech wherein a person is able to say a sound or word properly during normal instances but at other times it is not able to do so.
- At the beginnings and the ends of the words one tends to omit the use of consonants.
During childhood, speech apraxia rarely is seen alone. It is often accompanied by other deficits of language or cognitive which may be caused due to:
- Finding it difficult to chew or swallow.
- Problems grammatically
- Limited use of vocabulary
- Clumsiness
- Finding it difficult to coordinate and conducting fine motor skills
The other forms of apraxia include:
- Ideational apraxia – Difficulty carrying out complex tasks in a proper order. This type of apraxia is also called as conceptual apraxia. Patients tend to complete the tasks in an incorrect order. for example, they would butter the bread before putting it in the toaster or would put on their shoes before putting on the socks. The patient also is at loss of ability to perform voluntarily a learned task when a necessary object is given to them. For instance, if they were given a screwdriver, they would try to write with it or if given a toothbrush then they would try to comb their hair with it.
- Ideomotor apraxia – Inability to voluntarily perform a task even when objects are present. Individuals are unable to complete the motor actions which rely on semantic memory. Those individuals suffering from ideomotor apraxia can very well explain as to how to perform a certain action but unable to imagine or act out the movement. One of the examples would be that such individuals may not be able to pick up the phone when they are asked to do so but they can perform the action without thinking when the phone rings.
- Limb-kinetic apraxia – Difficulty moving legs and arms when needed. For example, in such instance an individual would find it difficult to wave a hello.
- Gait apraxia – This apraxia occurs when a person finds it difficult to perform normal functions which involves the lower limbs such as walking. One should note that this does not occur due to loss of motor or sensory functions.
- Oculomotor apraxia – In this instance an individual finds it difficult to move its eyes specially with saccade movements which help to direct the gaze to a specific target.
Occupational therapy and speech therapy are the two most common methods of treatment for this condition. If there is difficulty in understanding instructions occupational therapy becomes hard.
Diagnosis
For diagnosis apraxia of speech, there is no single procedure or test to get this identified hence diagnosis in such cases becomes difficult. The pathologist itself have different opinions when it comes to identifying the exact symptom which is leading to developmental apraxia. There are some doctors who tend to look at the presence of multiple symptoms which are quite common in apraxia. The doctor would check the ability of the patient to repeat a certain word multiple times and in some instance they would check whether a person can recite a list of words which becomes increasingly difficult. A speech language therapist would have an interaction with the child so as to assess which of the words, sounds and syllables the child is able to create and understand. At the same time, the doctor would conduct a physical examination of the child wherein they would check the child’s mouth, face and tongue for any signs of structural problems which could be the leading cause of apraxia symptoms.
The doctor would also look for other symptoms such as weakness or finding it difficult with language comprehension. If the doctor suspects the possibility of acquired apraxia, then they would suggest to go in for an MRI of the brain. This test becomes useful to determine the extent of brain damage and its exact location. When it comes to a child facing issues which speech apraxia the determination of whether the child is suffering from this problem cannot be made unless the child completes its second birthday. Since before this time, the child is unable to understand or even perform the tasks which is needed for determination of presence of apraxia.
Treatment methodologies to improve speech and language include:
In some instances, wherein a person has acquired apraxia, the condition tends to resolve spontaneously however it is not the same case with developmental apraxia of speech. This apraxia does not go away without treatments. There are various methods of treatments which are used for apraxia, but effectiveness varies from person to person. To get the best results from the treatment, the apraxia treatment itself must be developed in such a way that it meets the given needs of the individual. For instance, for children suffering from speech apraxia, a meeting of one on one with a speech and language therapist for around three to five times a week can do a lot of wonders. Alongside parents and guardian should also be able to help them in practicing the skills for further improvement.
Therapists also believe that by the use of sign language children who have difficulty in understanding would also benefit. Children are often recommended to attempt to speak words which they are signing for practice so as to allow the smooth flow of movement with their mouth.
- Repeating the sounds to improve movement of tongue and mouth
- Slowing down speech
- Working with melodies and rhythms
- Improving communication abilities
- Stringing together sounds so as to make speech
- Formation and pronunciations of sounds and words.
- One can also use multisensory approaches such as watch oneself in the mirror while trying to form certain words or touch the face while talking.
Sign language is also seen to be beneficial for people suffering from acquired apraxia. Such individuals can also electronic devices which can also include computers for producing sentences and words.
Prognosis
Patients suffering from apraxia become very much dependent for their activities on day to day basis. They require some level of supervision and skilled nursing care. Those patients who have degenerative disease or tumors usually need an increased level of dependence from others. Those suffering from stroke may have a stable course and show signs of improvement gradually.
