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Apraxia is a rare condition which affects only 0.1% of the population. Apraxia is a less well understood neurological condition and experts do not know whether the condition is genetic or not. It is unclear exactly how many people may be living with apraxia which is either going undiagnosed, or being misdiagnosed because of the lack of awareness or understanding of the condition.
What is apraxia?
Apraxia is a neurological condition which makes a person unable to perform familiar movements. It is a motor disorder which is caused by damage in the brain. The part of the brain which is damaged is the posterior parietal cortex or corpus callosum.
This makes it difficult to perform tasks or movements which an individual has previously been able to do. A person with apraxia has the capacity and the desire to make the movement but cannot achieve the motion. There is no muscle damage or any other physical reason that the person cannot achieve the desired movement.
Apraxia which occurs later in life is known as acquired apraxia. This is usually caused by a stroke, traumatic brain injury, Alzheimer’s disease, dementia, a brain tumour or other neurodegenerative disorder.
Some children can be born with apraxia and it is usually identified during their early stages of development.
When someone has a milder form of apraxia, this is called dyspraxia. Dyspraxia is also known as developmental coordination disorder (DCD). It is a disorder affecting fine and gross motor coordination. Dyspraxia is a neurological disorder that impacts someone’s ability to process and perform motor tasks. Dyspraxia is caused by the brain not processing information properly so that neural messages are not transmitted properly, causing difficulty planning and completing movement.
A person with dyspraxia may have difficulty with movement, spatial awareness, coordination, perception, memory and processing. Dyspraxia can also affect a person’s immune and nervous system. In many cases, dyspraxia can also affect speech or cause speech problems. Although dyspraxia does not affect intelligence, a child with dyspraxia may experience learning problems or a learning delay because of the challenges that they face.
The types of apraxia
Apraxia can present itself in several different forms which may occur alone or together.
- Ideomotor apraxia – This is the inability to mimic someone else’s actions or to follow an instruction.
- Lamb-kinetic apraxia – This is where someone is unable to make a precise movement with their finger, arm or leg even though they have been able to make this movement in the past.
- Ideational apraxia – This is where someone is unable to plan for a specific movement or follow a sequence of movements, for example getting dressed.
- Conceptual apraxia – This is where someone is unable to carry out multi-step actions or follow an instruction to carry out an action.
- Buccofacial apraxia – This is the inability to carry out facial and lip movements on command. This could include whistling, winking or yawning. Buccofacial apraxia is the most common type of apraxia.
- Constructional apraxia – This is where a person is unable to draw or copy simple diagrams.
- Oculomotor apraxia – This is where someone finds it difficult to move their eyes.
- Verbal apraxia (apraxia of speech) – This is where someone is unable to make the mouth movements in order to make sounds and speak. There are two different types of apraxia of speech: acquired apraxia and childhood apraxia of speech. Acquired apraxia can occur in people of all ages, but is typically seen in adults. This is where someone who once had the ability to speak is no longer able to. Childhood apraxia of speech is a motor speech disorder and the condition is present from birth. This is where they are unable to form sounds or words. Children with apraxia of speech can often understand language but are unable to form speech themselves.
Apraxia may be accompanied by a language disorder called aphasia. This is where an individual has difficulties with their language or speech and is common after having a stroke. The two conditions can sometimes be confused, especially as they can occur together.
Aphasia is where someone has difficulty in understanding or using words, making it difficult for them to speak, read or write. When someone has apraxia, they do not have any difficulties in understanding language, but they are unable to make the movements needed in order to speak.
When we speak, messages must go from the brain to the mouth in order to make the movement and produce the correct sound. The messages tell the muscles how and when to move in order to make sounds. If you have apraxia of speech, the messages are not sent correctly from the brain due to damage in the brain.
This means that you will not be able to use your lips or tongue in the right way to say words and sounds. Some people who have severe apraxia of speech cannot speak at all. If you have apraxia of speech you will have trouble saying sounds correctly. This may mean that you pronounce words incorrectly, or even say a different word or sound altogether.
What causes apraxia?
Apraxia occurs when certain parts of the brain stop working as they should. This is thought to be because of a lesion in the neural pathways of the brain where memories of how to make these movements are stored. This can happen due to a brain injury or a condition that affects the brain.
- A stroke.
- Alzheimer’s disease.
- A brain tumour.
- Another metabolic or neurological condition.
Experts do not yet understand what causes childhood apraxia of speech. Some experts believe that it is caused by signalling problems between the brain and the muscles used for speaking. Current research is focussing on whether specific brain abnormalities can be seen in people who have apraxia of speech and exactly which parts of the brain are linked to the condition.
What are the signs and symptoms of apraxia?
The main symptom of apraxia is the inability to carry out simple movements even though there is no physical reason that you cannot carry out the movement and you have the understanding of the requested instruction.
If you have apraxia of speech, you may experience the following symptoms:
- You may be able to say something correctly on one occasion but incorrectly on another occasion.
- You may have difficulty moving your tongue and lips in order to make the correct sounds.
- You may have trouble imitating and saying sounds on your own. You may say the sound in the wrong way, add a new sound, or leave a sound off.
- You may speak more slowly.
- You may have less difficulty saying words you use all the time, for example “hello” or “thank you”.
- You may have difficulty saying long or complex words.
- You may make excessive use of non-verbal communication.
- You may not be able to speak or make any sounds at all. This happens in very severe cases.
Childhood apraxia of speech is usually accompanied by other language or cognitive difficulties.
Symptoms of childhood apraxia may include:
- Minimal babbling as an infant.
- Limited vocabulary.
- Grammatical problems.
- Difficulties chewing and swallowing.
- Problems with coordination and fine motor skills.
How is apraxia diagnosed?
If you think you may have apraxia, you should see your GP. In order to diagnose apraxia, a doctor or healthcare professional will look at your full medical history and look at all of your symptoms and will try to identify the underlying cause. Similar conditions will be considered, such as aphasia, dyspraxia or motor weakness.
Your healthcare professional should carry out a number of tests in order to carry out a full assessment.
These may include:
- Verbal and non-verbal communication.
- Hearing and listening abilities.
- How you participate and your abilities in different activities.
Tests may include both physical tests to assess motor coordination skills and language tests to check the ability to understand instructions.
If you think you have apraxia of speech, you will be referred to a speech therapist in order to assess you and determine which course of treatment would be most appropriate.
There is not a single test which is used in order to diagnose childhood apraxia of speech. Different experts also disagree upon which symptoms indicate that the condition is present.
A speech therapist would usually look for the common symptoms of apraxia of speech and they may complete simple tests, for example asking the child to repeat a word several times. It will also be important for them to just generally interact with a child and to assess which sounds, syllables and words they are able to say and understand.
It will also be important for the assessing person to gather information from the parent or carer about the child’s abilities as most children will be different and likely more confident in their own familiar environment. The healthcare professional will also want to know your child’s medical history, including when you first noticed symptoms and whether there were any other developmental delays.
The speech therapist should also examine the child’s mouth, tongue and face in order to ensure that there are not any structural problems that could be causing apraxia symptoms.
A diagnosis of apraxia of speech cannot usually be made before a child’s second birthday. This is because, before this age, most children would not have the understanding in order to complete the assessment needed to determine the presence of apraxia. If your child meets the criteria, a formal diagnosis will be made, and a report will be sent to you.
How is apraxia treated?
When apraxia is a symptom of another condition, the underlying condition should be treated.
Treatment for apraxia includes:
- Speech therapy.
- Occupational therapy.
- Physical therapy.
The therapies available to treat the condition might include:
- Learning to write or draw or use a computer to express yourself.
- Working on speech rhythms using metronomes or finger clicking.
- Developing sounds through repetition and practising accompanying movements.
If you have apraxia of speech, regular sessions with a speech therapist are recommended as the most effective form of treatment. Having speech therapy may improve your symptoms but may not provide you with a cure.
Speech therapy is the assessment and treatment of communication difficulties and speech disorders. It usually begins with an assessment by a speech therapist in order to identify the type of communication disorder and make a plan for how best to treat this.
Sessions during speech therapy can include:
- Learning sign language, if you have severe difficulty with speech.
- Using all of your senses to help with speech – This may include listening to sounds and studying how the mouth is making sounds.
- Learning how to use your mouth muscles to make certain sounds.
In some instances of acquired apraxia, the condition can resolve spontaneously. It is not always possible to successfully treat apraxia, as this is dependent on the type of apraxia and the reason for it.
Childhood apraxia of speech can have good outcomes after treatment, with the child experiencing significant improvements. Treatment can help manage symptoms of apraxia. The earlier a diagnosis is made, the more successful treatments are likely to be.
Once a diagnosis has been made, healthcare professionals will work together to create a treatment plan. The treatment plan is likely to involve several specialists and different therapies.
Therapy for childhood apraxia of speech aims to improve speech coordination.
This can include:
- Practising putting sounds together to make words.
- Working on rhythms of sounds.
- Looking into a mirror while making sounds.
- Repeating the formation of sounds and words.
Many therapists will recommend sign language as a way for children to communicate, while also practising saying the word alongside the sign.
Living with apraxia
Some people living with apraxia can see their symptoms improve over time; however, some people do not show any signs of improvement and this can largely depend on the underlying cause of their apraxia.
Adults or children with apraxia will need to manage their symptoms, usually throughout their whole lives.
Physical, speech and occupational therapy is usually the most effective form of treatment and can really help in managing symptoms.
People with severe forms of apraxia may require high levels of support in completing day-to-day tasks and may not be able to live independently. Sign language is often recommended if appropriate as a way to communicate if apraxia symptoms are severe.
If your child is living with apraxia, you can access support through Apraxia Kids who offer online support groups to ensure that no family feels alone on their journey.
The Brain Charity offers support to carers of people living with apraxia.