What Is Apraxia?
Apraxia is essentially a neurological disorder related to the muscles. The patient is unable to perform certain tasks as commanded or carry out some physical activity despite being physically fit and the willingness to do so. The disease may afflict people of all ages, with children being the major sufferers. Certain motor movements of the patients are affected despite the muscles being normal. The patients suffering from this disease aren’t paralytic either. Apraxia has a milder form too, called ‘Dyspraxia’.
Let’s understand the disease even better. The patient with this neurological disorder understands the command well but is not able to perform the tasks as demanded, despite the willingness to carry out the task but miserably failing to execute it. These tasks may include the inability to button shirts or tie shoelaces etc.
What are the Causes of Apraxia:
The damage to the brain is the real cause of Apraxia. It is of two types – Apraxia of speech and Acquired Apraxia.
Apraxia of speech is also sometimes found to be present with aphasia, another form of speech disorder. Many other nervous systems or brain problems may exist, which mostly depends on the cause of apraxia. During apraxia of speech, the patient faces difficulty or inability to move his/her tongue and mouth to speak, even though his/her tongue and mouth muscles are capable to form words and he/she wants to speak.
The apraxia of speech has two forms – acquired apraxia and developmental apraxia. People of all ages can be afflicted with acquired apraxia and is typically found in adults. The people with this condition lose their abilities of speech-making once they acquire it. However, developmental apraxia is also called childhood apraxia of speech and is present at birth itself. The children suffering from this condition have the ability to understand speech but can’t express themselves by speaking legible words. By administering correct treatment, a significant improvement can be seen in the majority of children, if not complete recovery.
Acquired apraxia is caused when a person previously performing the tasks or certain physical activities develops apraxia at a later stage. It is mostly caused due to traumatic brain injury, stroke, dementia, neurodegenerative illness or brain tumor.
In some cases, apraxia is also seen at birth and the symptoms start appearing as the child develops and grows. Scientists and researchers are yet to identify the cause behind apraxia at birth. However, according to some scientists, this may be resulting from signaling problems between the muscles used for speaking and the brain. The focus of the ongoing research is to identify brain abnormalities causing apraxia of speech. Researchers are also studying the genetic causes of apraxia. Other studies are focusing on identifying as to which parts of the brain are exactly linked to this condition.
What are the Symptoms:
The patient suffering from apraxia will find it difficult or impossible to put together the muscle movements correctly. The patient can be seen performing a different task or physical activity instead of the one he/she was expected to do when requested or commanded. The patient is often aware and knows about the mistake he/she has committed because of the inability.
When the patient suffers from apraxia of speech then the symptoms may include poor speaking ability or speech inconsistencies, ability to speak short sentences of everyday use (e.g. “How are you?”) without any difficulty, more problem to use longer words either sometimes or at all time, great struggle in pronouncing the right word, and/or left out, repeated or distorted speech words or sounds.
Many speech-related symptoms are usually associated with apraxia. These among others include leaving out consonants during the beginning and end of words, distorted vowel sounds, nonverbal communication forms being excessively used, stresses or incorrect inflections on certain words or sounds, minimal or slight babbling during infancy, and/or difficulty or inability to string syllables together in the correct order for making words.
It’s rare that childhood apraxia of speech occurs alone, and is seen to often come along with other cognitive or language deficits. This may cause clumsiness, chewing and swallowing difficulties, grammatical problems, and limited vocabulary.
Apraxia is categorized in different types, such as Oculomotor, Motor, Ideokinetic, Ideational, Constructional, Classic and Buccofacial. As such, these types have different symptoms.
The face movements of a patient suffering from buccofacial or orofacial apraxia are impacted. The patient can’t whistle, stick out the tongue or lick the lips when demanded. The patient afflicted with ideational apraxia is not able to perform complex tasks in their proper order, such as wearing shoes before putting on socks. When the patient is suffering from ideomotor apraxia he/she is unable to perform voluntarily whenever provided a tool, such as trying to write with a screwdriver as though it was a pen. The patient who has ideokinetic apraxia has great difficulty to make precise movements with his/her leg or arm. The patient suffering from oculomotor apraxia finds difficulty in moving his/her eyes. The patient’s ability to construct simple figures or drawing or copying simple diagrams is impacted when he/she suffers from constructional apraxia.
Medical researchers widely believe that a lesion in the neural pathways of the brain containing the learned patterns of movement caused due to certain neurological, metabolic or other disorders is the main cause of apraxia. The frontal lobe (inferior parietal lobule) of the brain’s left hemisphere is particularly affected. This region of the brain stores complex, 3-D images of previously learned patterns. The patient suffering from the disease is not able to retrieve the 3-D representations of stored skilled movements.
Researchers attribute the cause of oculomotor apraxia to be genetic, inherited from either father or mother affected with the disease. Lesions (tissue or cellular damage) to some specific areas of the brain caused due to dementia, tumor, wound or stroke may also be attributed as one of the reasons behind apraxia. These specific regions of the brain include the so-called corpus callosum or premotor cortex (supplementary motor area).
If apraxia has been caused due to a stroke then it generally abates within weeks. It has been sometimes seen that apraxia in some cases is congenital. The primary cause of a child born with apraxia is due to the improper formation of the central nervous system. If you see a person whose intellectual functioning is deteriorating (degenerative dementia) then he/she has a high chance of developing apraxia.
Diagnosis for Apraxia:
The doctors recommend various examinations and tests to diagnose the cause of apraxia if they are unable to identify it. These tests include CT or MRI scans of the brain to know about a possible stroke, tumor, or other brain injury; an EEG (electroencephalogram) for ruling out epilepsy as one of the causes of apraxia; conducting a spinal tap for checking an infection or inflammation affecting the brain; and/or intellectual and standardized language tests when apraxia of speech is suspected. The patient may also be recommended for other learning disabilities testing and examination.
In fact, apraxia of speech can be diagnosed after conducting several different types of tests or procedures. The diagnosis, in this case, is quite complicated because of the widely differing opinions of speech-language pathologists regarding the varied symptoms indicating developmental apraxia. Most experts are able to diagnose apraxia of speech only after they make sure that multiple, common symptoms of the condition were present. A patient’s ability to repeating a word multiple times may be assessed. The experts may also examine if the patient is able to recite a list of more difficult words, such as “play, playful, playfully”.
Moreover, for diagnosing apraxia of speech a speech-language pathologist may be interacting with a child for assessing as to which words, syllables, and sounds the child can make and understand. The child’s face, tongue, and mouth will also be examined by the pathologist for identifying any structural problems which may be a cause of apraxia symptoms.
After apraxia has been diagnosed the experts may further want to assess whether other symptoms are present or not. For example, the speech-language pathologist might look for difficulties or weakness with language comprehension. These may be indicative of other conditions and significantly helps in ruling out apraxia with their presence. An MRI of the brain would be useful for a patient with possible acquired apraxia for determining the location and extent of any brain damage.
It may be noted that the diagnosis of childhood apraxia of speech is typically not possible in any way before a child’s second birthday. Most children during their first year are not able to either understand or perform the required tasks to identify the presence of apraxia.
Childhood apraxia of speech may be considered a part of a larger disorder when the child is suffering from neuromuscular disorders, certain mitochondrial disorders, galactosemia, epilepsy, autism, cerebral palsy, and other intellectual disability. In cases of many children, it is seen that a member of the child’s family is already having a learning disability or a communication disorder. It can prove to be quite difficult in diagnosing childhood apraxia of speech as it is a complex disorder. The diagnosis of the condition can be done only by a speech-language pathologist, who is quite experienced and have expertise in assessing speech problems with ease.
Treatment for Apraxia:
It has sometimes been seen that the condition of a patient with acquired apraxia in some cases is resolved spontaneously. This, however, isn’t possible in cases of developmental apraxia of speech unless effective treatment is done. Different treatment approaches can be used for apraxia and their efficacy varies depending on person to person. For achieving the best results, the treatment of apraxia should be developed keeping in view the individual patient’s condition and needs. Many children suffering from apraxia of speech have benefited from a one-on-one meeting with a speech-language pathologist at least three (3) to five (5) times per week.
Proper treatment to patients suffering from apraxia by a healthcare team can benefit them greatly. Apart from medical professionals, the healthcare team should also comprise of family members as well. The important role in administering treatment to patients suffering from apraxia is played by occupational and speech therapists. The family members and other caregivers who also form a crucial part learn ways of dealing with the disorder gradually.
The occupational and speech therapists during the course of treatment will be primarily focusing on teaching various techniques to the patient for helping him/her with communication, slowing down the patient’s speech, and sounds repetition over and over again for teaching mouth movements. It is also important to recognize and treat depression in a patient with apraxia.
The family members and other caregivers such as friends also have a key role to play to help the patient with communication skills. They should not assume that the patient is capable of understanding every command they give. Their tone of voice should be normal when speaking to the patient. Do remember that apraxia of speech is strictly not a hearing problem. Simple phrases should be used so that misunderstandings are avoided. Don’t give complex directions to the patient as it will be difficult for him/her to understand and implement the command. The patient should be provided with appropriate communication aids, if necessary, depending on his/her condition.
Other methods of treatment are also involved, which pertains to the patient’s daily living. The patient with apraxia should be kept in a calm and relaxed environment. The patient should be handled with utmost care and patience. The family members should take time to show the patient how to do a certain task and allowing him/her sufficient time to do so. The patient should not be asked for repeating the task when he/she is unable to do or seen struggling with it. This will only add to his/her predicament and increase frustration. If a patient struggles to do a certain task then he/she may be suggested some other ways to complete the same task. The patient should be provided mental health counseling if the frustration or depression is found to be severe.
The patient with apraxia who suffered a head injury or stroke will be benefited when given physical and occupational therapy. For children with apraxia, physical therapy and special education programs will go a long way in helping them learn to cope up with deficits as they grow older gradually. Special education and speech therapy will be quite helpful to treat patients afflicted with developmental apraxia of speech.
Sign language for children is also considered to be beneficial by many therapists who are difficult to be understood. Such children are recommended by therapists to make attempts in saying the words they are signing in order to practice to make the required movements with their mouths. The patients with extreme cases of acquired apraxia are also likely to benefit greatly from sign language. Using assistive electronic devices, such as computers for producing words and sentences, are recommended for such patients with acquired apraxia.
There are several home remedies to help the patient with apraxia to cope up with his day-to-day living with less difficulty. For a child with apraxia, the parents have a major role in helping him/her with speech and language skills improvement. Apart from speech therapy sessions, the child’s progress largely depends on rigorous home practice as well. The child must be encouraged and given support when practicing speech and language skills. This is important for your child to realize and feel good that he/she is performing well and improving. You must take care of scheduling different types of therapy at different times in case your child has to be given speech therapy as well as occupational or physical therapy. It is important to avoid your child being stressed or becoming too tired from different therapies.
Apraxia can be treated through other home remedies too. In the present times, naturopathy or cure through herbal medicines has caught everybody’s attention. People in Western countries are also showing interest in alternative medical approaches and have even started asking for them as an effective healing process. A perennial, creeping herb named Bacopa monnieri (water hyssop, thyme-leafed gratiola) found in the wetlands of North and South America, Asia, Africa, Europe, Australia, and eastern and southern India, is believed to be effective cure for speech delay as it consists of saponins, positively impacting the neurotransmitters in the patient’s brain. Serotonin levels also increase in enhancing neurological functions. Ten (10) ml of oil extracted from Bacopa monnieri (called Brahmi in India) herb should be applied on the patient’s scalp for massaging and washed off the next morning. Extracts from Convolvulus pluricaulis (known Shankhpushpi in India) herb has been used as a brain tonic traditionally. This herb is commonly found in Myanmar and India. Apraxia symptoms can also be gotten rid of by chewing one dried edible fruit of Phyllanthus emblica or emblic myrobalan or Indian gooseberry (called Amla in India) daily. It has neuroprotective properties and helps in strengthening muscles and promoting better speech.
Apraxia is not a disease that should be dreaded. It is true that the disease can’t be cured permanently, but the patient can show significant improvement in his/her condition when handled with empathy, love, and proper care. The patient afflicted with the disease suffers from low self-esteem and faces social problems. He/she, therefore, need support and encouragement from family members and made to feel confident about doing well and showing improvement. Long-term occupational and speech therapy will go a long way in dealing with this neurological, muscle disorder effectively.
We should clearly understand that apraxia essentially isn’t a problem related to language comprehension. It’s more about the patient’s inability to initiate and perform muscle movements of tongue and mouth for making a speech, as well as the difficulty to perform certain physical activities coherently and in the correct order. The healthcare team and caregivers, including medical professionals, occupational or speech therapists, and the patient’s family and friends need to understand his/her condition and accordingly proceed with the patient’s healing process. Patience is the key to effectively handle patients with apraxia symptoms. The fact that many patients with apraxia can’t act independently and have difficulty to perform day-to-day tasks, it is best to seek advice from the healthcare provider regarding the activities that will be safe for the patients. Proper safety measures need to be taken to avoid activities likely to cause injury. Complete care needs to be taken to reduce the risk of brain injury and stroke, which will help in preventing conditions that may cause apraxia.
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