Sunday, September 19, 2010

What is Apraxia?

I spent last week presenting in North Carolina and Virginia and met a lot of wonderful therapists who spend their days helping young children learn how to talk.  Thanks for the great week!

Today I want to talk about what apraxia is and what is isn't.  There are many clinical definitions of apraxia available, yet it can be a very abstract concept to understand.  First of all, I think it is important to note that there are 3 types of apraxia...limb apraxia, oral apraxia and verbal apraxia.  Let's look at these definitions first:

Limb apraxia:  Often referred to as dyspraxia.  Refers to the inability to make precise movements with the fingers, arms or legs on command.

Oral Apraxia:  Refers to the inability to coordinate and carry out oral/facial movements on command (not related to talking).

Verbal Apraxia:  Refers to the inability to coordinate and sequence sounds necessary for speech on command.

Both adults and children can have apraxia.  Typically we talk about acquired apraxia vs. childhood apraxia.  Acquired apraxia is due to brain damage and there is a loss of skill.  For example, following a stroke a person may have acquired apraxia.  However, when young children never learn to talk due to difficulty with motor planning, we refer to it as Childhood Apraxia of Speech (CAS). 

So, what is CAS?  There are 2 things it is and 2 things it isn't:

Two things CAS is:
1.  CAS is a neurological, brain-based disorder that requires intervention (it is not a developmental delay)
2.  CAS interferes with the ability to coordinate and sequence sounds necessary for speech on command

Two things CAS isn't:
1.  CAS isn't associated with cognitive deficits (however, children with cognitive deficits can also have CAS)
2.  CAS isn't associated with neuromuscular deficits (drooling, for example, is related to muscular weakness or dysarthria, not apraxia)

In a nutshell, a child with Childhood Apraxia of Speech (CAS) has difficulty with motor planning.  The child knows what he or she wants to say, but can't get the message from the brain to the mouth.  Basically, the brain says "speak" but the mouth doesn't respond. 

So, the purpose of early intervention in young children with suspected CAS is to build new neural pathways or fix existing ones and and teach them HOW to talk. 

Join me tomorrow as we continue to discuss Childhood Apraxia of Speech.

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