apraxia

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Apraxia

 

Definition

Apraxia is neurological condition characterized by loss of the ability to perform activities that a person is physically able and willing to do.

Description

Apraxia is caused by brain damage related to conditions such as head injury, stroke, brain tumor, and Alzheimer's disease. The damage affects the brain's ability to correctly signal instructions to the body. Forms of apraxia include the inability to say some words or make gestures.
Various conditions cause apraxia, and it can affect people of all ages. A baby might be born with the condition. A car accident or fall that resulted in head trauma could lead to apraxia.
From 500,000 to 750,000 people need to be hospitalized each year for head injuries according to the American Medical Association (AMA). Men between the ages of 18 and 24 form the largest group of people with head injuries. While not all severe injuries result in apraxia, men in that age group are at risk.
Risk factors for strokes include high blood pressure, diabetes, and heart disease. Cigarette smoking also puts a person at risk for a stroke. Brain tumors are abnormal tissue growths in the skull. They may be secondary tumors caused by the spread of cancer through the body.
There is more than one type of apraxia, and a person may have one or more form of this condition. Furthermore, a milder form of apraxia is called dyspraxia.

Causes and symptoms

Apraxia is caused by conditions that affect parts of the brain that control movements. Apraxia is a result of damage to the brain's cerebral hemispheres. These are the two halves of the cerebrum and are the location of brain activities such as voluntary movements.
Apraxia causes a lapse in carrying out movements that a person knows how to do, is physically able to perform, and wants to do. A person may be willing and able to do something like bathe. However, the brain does not send the signals that allow the person to perform the necessary sequence of activities to do this correctly.

Types of apraxia

There are several types of apraxia, and a patient could be diagnosed with one or more forms of this condition. The types of apraxia include:
  • Buccofacial or orofacial apraxia is the inability of a person to follow through on commands involving face and lip motions. These activities include coughing, licking the lips, whistling, and winking. Also known as facial-oral apraxia, it is the most common form of apraxia, according to the National Institute of Neurological Disorders and Stroke (NINDS).
  • Limb-kinetic apraxia is the inability to make precise movements with an arm or leg.
  • Ideomotor apraxia is the inability to make the proper movement in response to a command to pantomime an activity like waving.
  • Constructional apraxia is the inability to copy, draw, or build simple figures.
  • Ideational apraxia is the inability to do an activity that involves performing a series of movements in a sequence. A person with this condition could have trouble dressing, eating, or bathing. It is also known as conceptual apraxia.
  • Oculomotor apraxia is characterized by difficulty moving the eyes.
  • Verbal apraxia is a condition involving difficulty coordinating mouth and speech movements. It is referred to as apraxia of speech by organizations including the American Speech Language Hearing Association (ASHA).
A baby who does not coo or babble may display a symptom of apraxia of speech, according to ASHA. A young child may only say a few consonant sounds, and an older child may have difficulty imitating speech. An adult also has this difficulty. Other symptoms include saying the wrong words. A person wants to say "kitchen," but says "bipem" instead, according to an ASHA report.
A person diagnosed with apraxia may also have aphasia, a condition caused by damage to the brain's speech centers. This results in difficulty reading, witting, speaking, and understanding when others speak.

Post-apraxia changes

A person with apraxia could experience frustration about difficulty communicating or trouble performing tasks. In some cases, the condition could affect the person's ability to live independently.

Diagnosis

Diagnosis of apraxia could begin with testing of its underlying cause. Testing for conditions like a stroke or cancer includes the MRI (magnetic resonance imaging) and CT scanning (computer tomography scanning). A brain biopsy is used to measure changes caused by Alzheimer's disease. In all cases, the physician takes a family history. Head trauma that could cause apraxia is first treated in the emergency room.
Other diagnostic treatment is related to identifying the type of apraxia. For example, the physician may ask the patient to demonstrate how to blow out a candle, wave, use a fork, or use a toothbrush.
Assessment for speech apraxia in children includes a hearing evaluation to determine if difficulty in speaking is related to a hearing loss. If the condition appears related to apraxia, a speech-language pathologist examines muscle development in the jaw, lips, and tongue. The examination of adults and children includes an evaluation of how words are pronounced individually and in conversation. The pathologist observes how the patient breathes when speaking and the ability to perform actions like smiling.
The costs of diagnosis vary because the process could include examinations and diagnostic screening related to the underlying cost of the apraxia. Insurance generally covers part of these costs.

Treatment

The treatment for apraxia usually involves rehabilitation through speech-language therapy, physical therapy, or occupational therapy. In addition, treatment such as chemotherapy is administered for the condition that caused the apraxia.

Key terms

CT scanning — Computer tomography scanning is a diagnostic imaging tool that uses x rays sent through the body at different angles.
MRI — Magnetic resonance imaging is a diagnostic imaging tool that utilizes an electromagnetic field and radio waves.
Family education is an important component of apraxia treatment. The rehabilitation process takes time, and relatives can offer encouragement and support to the patient. They may be asked to help the patient with in-home exercises. Furthermore, family members sometimes need to take on the role of caregivers.

Speech-language therapy

Speech-language therapy focuses on helping the patients learn or regain communication skills. Therapists teach exercises to strengthen facial muscles used in speech. Other exercises concentrate on patients learning to correctly pronounce sounds and then turn those sounds into words.
In cases where apraxia limits the ability to speak, therapists help patients develop alternate means of communication. These alternatives range from gesturing to using a portable computer that writes and produces speech, according to ASHA.

Occupational and physical therapies

Occupational and physical therapies focus on helping patients regain the skills impaired by apraxia. Physical therapy exercises concentrate on areas such as mobility and balance. Occupational therapy helps patients relearn daily living skills.

Treatment costs

The costs of therapy vary by the type of treatment, regional location, and where the therapy is offered. Fees can range for $40 per hour for in-office speech therapy for a child to $85 per hour for in-home physical or occupational therapy for a senior citizen. Part of therapy costs may be covered by insurance.

Alternative treatment

Most alternative treatments target Alzheimer's disease and other conditions that cause apraxia. Herbal remedies thought to help people with Alzheimer's include ginkgo biloba, a plant extract. However, organizations including the Alzheimer's Association caution that the effectiveness and safety of this herbal remedy has not been evaluated by the U.S. Food and Drug Administration. The government does not require a review of supplements like ginkgo. Furthermore, there is a risk of internal bleeding if ginkgo is taken in combination with aspirin and blood-thinning medications.

Prognosis

The prognosis for apraxia depends on factors such as what caused the condition. While Alzheimer's is a degenerative condition, a child with verbal apraxia or a stroke patient could make progress.
In some cases, treatment helps a person to relearn or acquire skills needed to function. A caregiver may be required, and some people with dementia require supervised, longterm care.

Prevention

The methods of preventing apraxia focus on preventing the underlying causes of this condition. This may not be entirely possible when there is a family history of conditions such as stroke, dementia, and cancer. However, a person at risk by not smoking, exercising, and eating a diet based on the American Heart Association guidelines.
Head injury can be prevented by wearing a helmet when participating in activities like sports and bicycling. Wearing a seatbelt when in a vehicle also helps reduce the risk of head injury.

Resources

Books

Periodicals

Organizations

American Speech Language Hearing Association. 10801 Rockville Pike, Rockville, MD 20852-3279. 800-638-8255. http://www.asha.org.
Alzheimer's Association. 225 North Michigan Avenue, Floor 17, Chicago, IL 60601. 800-272-3900. http://www.alz.org.
National Institute of Neurological Disorders and Stroke, NIH Neurological Institute. P.O. Box 5801, Bethesda, MD 20824. 800-352-9424. http://www.ninds.nih.gov.
National Rehabilitation Information Center. 4200 Forbes Boulevard Suite 202, Lanham, MD 20706-4829. 800-346-2742. http://www.naric.com.
National Stroke Association. 9707 East Easter Lane, Englewood, CO 80112. 1-800-787-6537. http://www.stroke.org.

Other

"Apraxia in Adults." American Speech Language Hearing Association. 2005. [cited March 29, 2005]. http://www.asha.org/public/speech/disorders/apraxia_adults.htm.
"Childhood Apraxia of Speech." American Speech Language Hearing Association. 2005. [cited March 29, 2005]. 〈http://www.asha.org/public/speech/disorders/Developmental-Apraxia-of-Speech.htm〉.
Jacobs, Daniel H., M.D."Apraxia and Related Syndromes." e-medicine. October 27, 2004 [cited March 29, 2005]. http://www.emedicine.com/neuro/topic438.htm.
"NINDS Apraxia Information Page." National Institute of Neurological Disorders and Stroke February 09, 2005 [cited March 29, 2005]. http://www.ninds.nih.gov/disorders/apraxia/apraxia.htm.

apraxia

 [ah-prak´se-ah]
loss of ability to carry out familiar purposeful movements in the absence of sensory or motor impairment, especially impairment of the ability to use objects correctly.
amnestic apraxia loss of ability to carry out a movement on command due to inability to remember the command.
apraxia of gait a common disorder of the elderly in which the patient walks with a broad-based gait, taking short steps and placing the feet flat on the ground.
motor apraxia impairment of skilled movements that is not explained by weakness of the affected parts; the patient appears clumsy rather than weak.
sensory apraxia loss of ability to make proper use of an object due to lack of perception of its purpose.
apraxia of speech a speech disorder similar to motor aphasia, due to apraxia of mouth and neck muscles because of a lesion interfering with coordination of impulses from Broca's motor speech area. Called also aphemia.

a·prax·i·a

(ă-prak'sē-ă),
1. A disorder of voluntary movement consisting of impairment of the performance of skilled or purposeful movements, notwithstanding the preservation of comprehension, muscular power, sensibility, and coordination in general; results from acquired cerebral disease.
2. A psychomotor defect in which the proper use of an object cannot be carried out although the object can be named and its uses described.
[G. a- priv. + prattō, to do]

apraxia

/aprax·ia/ (ah-prak´se-ah) loss of ability to carry out familiar purposeful movements in the absence of motor or sensory impairment, especially inability to use objects correctly.
amnestic apraxia  loss of ability to carry out a movement on command due to inability to remember the command.
Bruns' apraxia of gait  Bruns' frontal ataxia.
Cogan's oculomotor apraxia , congenital oculomotor apraxia an absence or defect of horizontal eye movements so that the head must turn and the eyes exhibit nystagmus in attempts to see an object off to one side.
ideational apraxia  sensory a.
innervatory apraxia , motor apraxia impairment of skilled movements not explained by weakness of the affected parts, the patient appearing clumsy rather than weak.
sensory apraxia  loss of ability to use an object due to lack of perception of its purpose.

apraxia

(ā-prăk′sē-ə)
n.
Total or partial loss of the ability to perform coordinated movements or manipulate objects in the absence of motor or sensory impairment.

a·prac′tic (ā-prăk′tĭk), a·prax′ic (ā-prăk′sĭk) adj.

apraxia

[əprak′sē·ə]
Etymology: Gk, a + pressein, not to act
an impairment in the ability to perform purposeful acts or to manipulate objects without any loss of strength, sensation, or coordination. Apraxia of speech is an inability to program the position of speech muscles and the sequence of muscle movements necessary to produce understandable speech, although understanding of speech remains intact. See also amnestic apraxia, ideational apraxia, and motor apraxia. apraxic, adj.

apraxia

Neurology A disorder of motor function characterized by an inability to execute a skilled or learned or purposeful motor act, despite normal muscle function, unrelated to paralysis or lack of comprehension Etiology Cortical lesions. See Construction apraxia, Ideational apraxia, Ideokinetic apraxia, Ideomotor apraxia, Neurapraxia.

a·prax·i·a

(ă-prak'sē-ă)
1. A disorder of voluntary movement, consisting of impairment in the performance of skilled or purposeful movements, notwithstanding the preservation of comprehension, muscular power, sensibility, and coordination in general; due to congenital or acquired cerebral disease.
2. A psychomotor defect in which the proper use of an object cannot be carried out although the object can be named and its uses described correctly.
[G. a- priv. + prattō, to do]

apraxia

Loss of the ability to carry out skilled movements with control and accuracy. Apraxia is a common manifestation of STROKE.

Liepmann,

Hugo K., German neurologist, 1863-1925.
Liepmann disease - Synonym(s): apraxia

apraxia 

A disorder of voluntary movement, characterized by the inability to accomplish a skilled or purposeful movement, in the absence of motor paralysis, sensory loss or of a general lack of coordination. It is due to a cerebellar disease.
ocular motor apraxia A congenital inability to perform some voluntary ocular movements. Children with this condition often use head thrusts to move their eyes to the left or to the right.
optical apraxia Apraxia in which there is an inability to copy or to draw in proper spatial orientation. It is usually associated with visual agnosia. Syn. visual apraxia.
visual apraxia See optical apraxia.

apraxia (əprak´sēə),

n a loss of ability to execute a purposeful, goal-oriented, or skilled act resulting from selective damage to certain high-level brain centers, either sensory, motor, or both.

Patient discussion about apraxia

Q. What is Dyspraxia? My 5 year old son has been diagnosed with Dyspraxia. What is it? Does it have a cure?

A. Dyspraxia usually means that you son will have a hard time to learn and retain physical activities, and will also be hesitant and awkward in their performance. These are some of the symptoms you might notice in him now, before he reaches school age. The child is late in reaching milestones e.g. rolling over, sitting, standing, walking, and speaking. May not be able to run, hop, jump, or catch or kick a ball although their peers can do so, has difficulty in keeping friends; or judging how to behave in company. Has little understanding of concepts such as 'in', 'on', 'in front of' etc. Has difficulty in walking up and down stairs. Poor at dressing. Slow and hesitant in most actions. Appears not to be able to learn anything instinctively but must be taught skills. Falls over frequently. Poor pencil grip. Cannot do jigsaws or shape sorting games. Artwork is very immature. There is no cure for Dyspraxia, however your son can be taught to do everything by the appropriate specialists.

Q. My child, who has dypraxia, passed both TOVA & BRC. Help, I don't want to put him on ritalin but feel pres Since age 4 my child has received OT, ST and Physiotherpy. He is now 81/2 and has difficulties at school. Last year, after years of therapy, we went to a private Neuro Developmental Physiotherapist and she diagnosed him with Dyspraxia. I thought that my son was good at sport, but when she asked him to do the simplest of task like stand on one leg, or walk one foot infront of the other, he had great difficulty. He has diffculty processing information or thoughts and turning them into actions. This is especially evident in copying from the blackboard. His handwriting is extremely poor, even after many years, at much expence, of intense OT. His attention span is very poor, he daydreams and shuts down in class. The slightest noise, knock on the door, ticking clock etc wil break his concentration. He has passed both TOVA and BRC test, yet I am still under pressure from the school to put him on ritalin. I feel his concentration & attention problems are due to his Dyspraxia. Help

A. ritalin is not a sedative,it acts as a sedative in hyperative people.--methylphenidate is the same as ritalin but is cheeper. i know you are a good parent but sometimes you have to listen to the dr an therapist that work with these kinds of disorders.think about how this effects your child now--later on in life it might cause him to not go to college or get a job,not to say anything about his pears at school. there are a lot of other proplems with this disorder.

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