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

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.

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.

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.

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 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.

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.

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 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 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.

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.

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.

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.

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.

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.

"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.

 

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