Apraxia

Answer 1

Definition

Apraxia is a disorder of the brain and nervous system in which a person is unable to perform tasks or movements when asked, even though:

• The request or command is understood
• They are willing to perform the task
• The muscles needed to perform the task work properly
• The task may have already been learned

Alternative Names

Verbal apraxia; Dyspraxia; Speech disorder - apraxia; Childhood apraxia of speech; Apraxia of speech; Acquired apraxia

Causes, incidence, and risk factors

Apraxia is caused by damage to the brain. When apraxia develops in a person who was previously able to perform the tasks or abilities, it is called acquired apraxia.

The most common causes of acquired apraxia are:

• Brain tumor
• Condition that causes gradual worsening of the brain and nervous system (neurodegenerative illness)
• Dementia
• Stroke
• Traumatic brain injury

Apraxia may also be seen at birth. Symptoms appear as the child grows and develops. The cause is unknown.

Apraxia of speech is often present along with another speech disorder called aphasia. Depending on the cause of apraxia, a number of other brain or nervous system problems may be present.

Symptoms

A person with apraxia are unable to put together the correct muscle movements. At times, a completely different word or action is used than the one the person intended to speak or make. The person is often aware of the mistake.

Symptoms of apraxia of speech include :

• Speech sounds and words may be distorted, repeated, or left out. It is difficult to put words together in the correct order.
• Struggling or groping for the right word.
• Longer words are more difficult to use, either at all, or from one time or another.
• Short everyday phrases or sayings (such as "How are you?") can often still be used without a problem.
• The person often can write better than he or she can speak.

Other forms of apraxia include:

• Buccofacial or orofacial apraxia: Cannot carry out movements of the face on demand, such as licking the lips, sticking out the tongue, or whistling.
• Ideational apraxia: Cannnot carry out learned complex tasks in the proper order, such as putting on socks before putting on shoes.
• Ideomotor apraxia: Cannot voluntarily perform a learned task when given the necessary objects. For instance, if given a screwdriver, the person may try to write with it as if it were a pen.
• Limb-kinetic apraxia: This condition involves difficulty making precise movements with an arm or leg.

Frustration, profanity, and depression are typical responses in persons with aphasia.

Signs and tests

The following tests may be performed if the cause of the disorder is not known:

• CT or MRI scans of the brain may help show a tumor, stroke, or other brain injury
• An electroencephalogram (EEG) may be used to rule out epilepsy as a cause of the apraxia.
• A spinal tap may be done to check for inflammation or an infection that affects the brain.

Standardized language and intellectual tests should be done if apraxia of speech is suspected. Testing for other learning disabilities may also be needed.

Treatment

Speech and language treatment may include:

• Repeating sounds over and over in order to teach mouth movements
• Learning to slow down how the person talks
• Different techniques to help with communication

Recognition and treatment of depression is important for people with severe speech and language disorders.

Other tips:

• Maintain a relaxed, calm environment.
• Take time to show someone with apraxia how to do a task, and allow enough time for them to do so. Do not ask them to repeat the task if they are clearly struggling with it and doing so will increase frustration.
• Suggest alternative ways to do the same things, for example, try a hook and loop closure instead of laces for shoes.

When speech apraxia is present:

• Avoid giving complex directions.
• Use simple phrases to avoid misunderstandings.
• Speak in a normal tone of voice. Speech apraxia is not a hearing problem.
• Don't assume that the person understands.
• Provide communication aids, if possible, depending on the person and condition.

Many people with apraxia are no longer able to be independent and may have trouble performing everyday tasks Ask your health care provider which activities may or may not be safe. Avoid activities that may cause injury, and take the proper safety measures.

Expectations (prognosis)

Occupational therapy and counseling may help both patients and their caregivers learn ways to deal with the apraxia. However, because people with apraxia have trouble following instructions, occupational therapy for stroke or other brain injury is difficult.

Complications

• Learning problems
• Low self-esteem
• Social problems

Calling your health care provider

Contact your health care professional if someone has difficulty performing everyday tasks or has other symptoms of apraxia after a stroke or brain injury.

Prevention

Reducing your risk for stroke and brain injury may help prevent conditions that lead to aphasia.

References

Swanberg MM, Nasreddine ZS, Mendez MF, Cummings JL. Speech and language. In: Goetz CG, ed. Textbook of Clinical Neurology. 3rd ed. Philadelphia, PA: Saunders Elsevier; 2007:chap 6.

Kortte JH, Palmer JB. Speech and language disorders. In: Frontera, WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 145.

Reviewed By

Review Date: 07/23/2010

David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital.

Answer 2

Total or partial loss of the ability to perform coordinated movements or manipulate objects in the absence of motor or sensory impairment; specifically, a disorder of motor planning