By: Miss Khadija Abbasi
Apraxia
Apraxia refers to the loss or absence of the ability to perform learned purposeful movements, an impaired ability to plan, select, and sequence the motor execution of movements, which are all part of executive functioning (Gillian Fournier).
Different types of apraxia affect the body in slightly different ways:
Limb-kinetic Apraxia
The limb-kinetic apraxia people are unable to use their finger, arm, or leg to make accurate and coordinated movements. Even though people with limb-kinetic apraxia may understand how to use a tool, such as a screwdriver, and may have used it in the past, they are now unable to carry out the same movement.
Ideomotor apraxia
Another type of apraxia is ideomotor apraxia in which are unable to follow a verbal command to copy the movements of others or follow suggestions for movements.
Conceptual apraxia
This form of apraxia is similar to ideomotor apraxia. People with conceptual apraxia are not able to perform tasks that involve more than one step.
Ideational apraxia
Ideational apraxia is another type when people are unable to plan a particular movement. They may find it hard to follow a sequence of movements, such as getting dressed or bathing.
Bucco facial apraxia a
People with Bucco facial apraxia, or facial-oral apraxia, are unable to make movements with the face and lips on command.
Constructional apraxia
Constructional apraxia is another type in which person is able to copy, draw, or construct basic diagrams or figures.
Oculomotor apraxia
Oculomotor apraxia affects the eyes. People with this type of apraxia have difficulty making eye movements on command.
Verbal apraxia
People with verbal or oral apraxia find it challenging to make the movements necessary for speech. They may have problems producing sounds and understanding rhythms of speech
a). Developmental apraxia of speech is also known as childhood apraxia of speech. This condition is present from birth, and it affects a child’s ability to form sounds and words. Children with speech apraxia often have far greater abilities to understand speech than to express themselves with spoken words.
b). Acquired Apraxia of Speech: Acquired apraxia can occur in people of all ages. Mostly, though, it is found in adults. This condition causes people to lose the speech-making abilities they once possessed. Acquired apraxia of speech (AOS) is a treatable neurologic, sensorimotor speech disorder.
The primary clinical characteristics that are important for the diagnosis of AOS include:
1). a slow rate of speech resulting in lengthened sound segments and intersegment durations
2). Repeated attempts at pronunciation of words
3). Speech-sound errors such as sound distortions and/or distorted sound substitutions
4). Impaired rhythm and prosody (intonation) of speech
5). Incorrect inflections or stresses on certain sounds or words
6). Groping of the articulators to make specific sounds and word
7). Minimal babbling during infancy
10). Perseverative errors
11). increased errors with increased word length
12). Speech initiation difficulties
13). Excessive use of nonverbal forms of communication
Causes
Link Between Apraxia and Autism Spectrum Disorder
Connection Between Autism Spectrum Disorder and Apraxia
According to some theories, apraxia could be the reason why speech development is absent in ASD patients. Autism-related praxis deficits affect and hinder the learning and execution of a variety of motor commands in children. Stroke is a common cause of acquired apraxia. Progressive neurological disorders, brain tumors, dementia, and traumatic brain injury are some additional causes. The impact of mutations in the FOXP2 gene on speech, language processing, and motor coordination in the brain is still being investigated by researchers. It has been suggested that the neuroanatomical correlate of speech apraxia is the left insula or Broca’s area. Aphasia can result from lesions in the corpus callosum, left inferior parietal lobe, and premotor frontal cortex of either hemisphere. Children with comorbid intellectual disability (78.1%), autism spectrum disorder, receptive language impairment (72.5%), and nonspeech apraxia (37.3%; including limb, nonspeech oromotor, and oculomotor apraxia)
1. Motoric Practice
Repeated, motoric practice has been a primary component of most articulatory-kinematic treatment investigations which recently have been applied to speech learning/relearning, principles of experience-dependent neural plasticity involving rehabilitation following stroke or brain injury and neural models of speech production in the early stages of speech development and acquiring speech sounds.
2. Integral Stimulation
Practicing movement gestures for speech production that involves imitation and emphasizes multiple sensory models (e.g., auditory, visual, tactile). Treatment follows a “listen to me, watch me, do what I do” sequence, in which the individual hears and sees how the clinician produces a targeted sound sequence or word/phrase and then imitates
3. Articulatory Cueing
This technique increases awareness and actualization of articulatory postures and/or movements and may take the form of:
a). Phonetic placement cues use descriptions of what (articulators), where (location), how (manner, voicing) sounds are made, using descriptions from verbal explanations, visual modeling, drawings or physical cueing by the clinician of the orofacial musculature.
b). Phonetic derivation (root) is a shaping technique that builds upon the articulatory or orofacial skills in the patient’s repertoire. A clinician using this technique provides instructions or models how to modify existing speech or non-speech movements to produce the intended target.
4. Transcranial Direct Current Stimulation
An experimental procedure in which transcranial direct current is delivered to the left inferior frontal gyrus to modulate cortical activity. It has been used in conjunction with articulatory–kinematic treatment to improve the speech of individuals with AOS secondary to stroke. Speech targets consist of syllables and words that are presented auditorily and are repeated by the individual
Augmentative and Alternative Communication (AAC)
AAC involves supplementing or replacing natural spoken language with writing and/or aided (e.g., picture communication, line drawings, speech-generating devices, and tangible objects) or unaided (e.g., manual signs, gestures, and finger spelling) symbols. Electromagnetic articulography electropalatographic and spectrographic displays have been used with speakers with AOS. These approaches require additional equipment and expertise that may limit their appeal to clinicians but EPG and spectrographic analysis have become relatively accessible in terms of cost and usage.
5. Rate/Rhythm Control Treatment
Rhythmic-control treatments usually have involved slowing the rate of speech production in speakers who already exhibit a reduced production rate. The reduced rate is believed to allow additional time for speakers to reach their intended articulatory targets as well as to process sensorimotor feedback involved in speech production. These methods include finger-counting, pacing board practice and computerized pacing of oral reading
Metronomic Pacing
Speaker produces speech at the rate of one syllable or movement per beat of a metronome. Typically, the beat has been set at a rate significantly slower than the speaker’s habitual rate of speech. Behaviors targeted with this approach have varied from non-speech tasks (tongue movements) to speech tasks of varying lengths.
Metrical Pacing
Metrical pacing is similar to metronomic pacing, but the natural rhythm or prosody of the target utterances is maintained. Treatment involves computer-generated pacing tones for each utterance that maintain the natural rhythm of the utterance regardless of rate of production.
6. Rapid Syllable Transition Treatment (ReST)
This treatment incorporates sound and prosodic practice to develop sound production skills and appropriate prosody, particularly at the lexical level. Clinician should emphasize word stress and phrase-sentence intonation patterns. Imitate the child’s like if the child vocalizes moo, the SLP can imitate the sounds and then talk about the animal. Then clinician can expand to include a linguistic message.
7. Avoid emphasis on nonspeech preparatory stimulation
In favor of speech activities. If alveolar stops are being targeted, it would be better to attempt tuh, tuh rather than doing nonspeech activities such as just clicking the tongue. Make sounds that are meaningful and always pair the practice with words that are meaningful to the child.
8. Maximal Pairs Approach
Identify the two target phonemes. For example, the sounds /m/ and /f/ are maximally opposed across by place, manner and voicing (with /m/ being a bilabial voiced nasal and /f/ being a labiodental voiceless fricative). Remember the pair should include a known versus an unknown phoneme.
Create eight pairs of words containing the target phonemes. Where no true words are available, use nonsense words, which could be associated with different monster or fairy names. For example, Mip/Fip.
9. Multiple Input Phoneme Therapy
To develop the ability to repeat words, expand on any utterances the client already produces. Collect a list of utterances that the client produces. Then work to break any perseveration by intentionally inputting the words and then paired with a gestural cue (tapping client’s arm). Then gradually work on having the client repeat the word. The next step is to leverage the speech sounds he is already producing. You will use phonemes, or sounds, from each word to create a new list of words to target.
10. Building a core vocabulary
Chose the words based on everyday use (e.g., “mom,” “dad”), tell about the importance of speaking