Treatment of apraxia in Saratov, how to treat apraxia in Russia

Article:

Apraxia in speech therapy is a movement disorder that involves problems with the pronunciation of sounds, syllables and words.
The defect is not caused by muscle weakness or paralysis, but by pathological dysfunction of the brain. The child wants to pronounce a phrase, but the movements of his articulatory muscles are not coordinated.

Apraxia is distributed on a large scale throughout the world. Every year the percentage of children suffering from this diagnosis doubles. Approximately 10:1000, this number of patients are registered with apraxia.

Treatment of apraxia in Saratov, Russia, therapy of apraxia

Sarklinik provides treatment for certain types of apraxia in adults, adolescents, children, boys, girls, boys, girls, men, women in Saratov, Russia. The doctor knows how to treat apraxia , how to cure apraxia, how to get rid of apraxia, what to do with apraxia, where to go. At the first consultation, will the doctor tell you what types of apraxia there are? What are the characteristics of kinesthetic (kinetic) apraxia, aphasia and agnosia ? Why does oral apraxia, motor apraxia, constructive apraxia, articulatory apraxia, regulatory apraxia occur in children and adults? What is apraxia of walking and speech? What is the danger of motor left, right hand, left, parva leg, fingers, ideator apraxia? What are the principles for diagnosing apraxia ? Unfortunately, traditional methods, traditional medicine, diet, pills, medicines, drugs, traditional methods, spells, homeopathy rarely help in the treatment of apraxia. On the website sarclinic.ru you can see a doctor online for free.

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Apraxia

Apraxia (from the Greek a - prefix of negation, praxis - action) is a loss of memory of motor skills in the form of an inability to voluntarily perform sufficiently subtle purposeful actions while maintaining muscle strength and the ability to perform elementary motor acts. H. Liepman (1900), who first described apraxia, identified kinetic apraxia of the limbs, ideomotor apraxia, ideational apraxia and agraphia. Later, some other forms of apraxia became known. Apraxia deprives the patient of the practical ability to perform not only complex, but also the simplest skills, such as shaking hands, combing one's hair, lighting a match, fastening a button, etc. Manifestations of apraxia are difficult to clearly describe.

1. Kinetic apraxia of the limbs (acrokinetic motor apraxia) - loss of memory of skills of simple actions, including gestures. The patients' movements are awkward, imprecise, and seem to be inconsistent with a specific goal. Apraxia is unilateral and is associated with diffuse contraction of agonist and antagonist muscles. In the case of apraxia of gestures, the performance of elementary actions that are included in these gestures is impaired. Thus, the gesture “wagging a finger” is performed by moving the index finger in the sagittal plane. The disorder occurs when the left parietal lobe is damaged in the area bordering the posterior postcentral gyrus.

Kinesthetic apraxia (Liepmann, 1905; Heilbronner, 1905) is a form of acrokinetic motor apraxia. It is characterized by the loss of kinetic and kinesthetic images of limb movement. Patients cannot apply the required force when moving their fingers and hands, or accurately direct such efforts, which is why they become rough and undifferentiated. This disorder is associated with a lesion in the area of ​​the anterior and posterior central gyri.

Innervatory or premotor apraxia (Kleist, 1907) is manifested by the loss of the ability to perform complex and subtle actions developed through long-term life practice. Violations concern one limb or even part of it. Occurs when the premotor area of ​​the frontal cortex is damaged. In addition, bimanual apraxia has been described (Brown, 1972), with its inherent difficulties in patients performing complex objective and symbolic actions that require the combined work of both hands. The actions of each hand separately are not impaired (Ovcharova, Raitsev, 1980).

2. Ideomotor apraxia (Dejerine's execution apraxia) - loss of the ability to perform actions on command from the outside. The patient is able to describe the plan for this or that action, he can automatically perform it on his own (for example, light a match and smoke), but he cannot perform this action on command, or by imitation. At the same time, he seems to forget exactly what movements need to be made to carry out the action. The performance of actions in the absence of appropriate objects is especially severely impaired. For example, the patient cannot show how to cut wood, stir sugar in a glass of tea with a spoon, hammer a nail, etc.

Purposeful actions become deformed and diffuse, as they include movements from other actions. At the same time, synkinesis occurs. Meanwhile, symbolic actions are still performed without difficulty and correctly. Bilateral ideomotor apraxia most often occurs with damage to the supramarginal gyrus of the left parietal lobe. Less commonly, this occurs with right-sided damage to the parietal lobe, and apraxia is limited to the left limbs. Ideomotor apraxia in right-handers also occurs with right-sided damage to the parietal region, as well as when the source of damage is localized in the middle parts of the corpus callosum.

Kinetic (ideokinetic) and ideomotor apraxia are considered as variants of motor apraxia. Motor apraxia is generally characterized by perseveration of movements and disruption of the sequence of movements.

3. Ideatorial apraxia (apraxia of intention) is associated with the loss of memory traces of the desired image of an action or with the loss of the ability to detect this image in memory. Rarely found in isolated form. It is usually bilateral and affects all parts of the body. The patient seems to forget what and how the objects around him can be used. He can, however, repeat the doctor’s actions or correctly perform any fragment of the action, but he may not be able to independently carry out a complex sequence of movements.

For example, he cannot take a box of matches, remove one match from it, close the box, light the match, then light the candle and finally extinguish the match. Instead, understanding what they want from him, he turns the box for a long time, scratches the match on the other side of the box or with the wrong end of the match, puts an unlit match in his mouth, etc. Occurs when the angular and, partially, supramarginal gyri of the dominant hemisphere are damaged ( for right-handers - left). Ideatorial apraxia is almost always combined with elements of sensory aphasia, and sometimes with the phenomena of hemiplegia and hemianopsia (Khodos, 1974). Varieties of ideation apraxia include oral apraxia, trunk apraxia and dressing apraxia.

Oral apraxia is manifested in patients by the loss of the ability to perform simple articulatory postures as instructed, such as sticking out the cheek with the tongue, placing the tongue under the upper or lower lip, touching the corners of the mouth or upper lip with the tongue, etc. In addition, the intentional execution of externally required tasks suffers. symbolic actions such as clicking, whistling, spitting, smacking, etc. - symbolic apraxia. Swallowing apraxia is very rarely detected (some researchers classify it as facial apraxia). Patients perform all of these actions spontaneously, however, during eating, speaking, and communicating. Oral and symbolic apraxia usually accompany motor apraxia. The disorder occurs when the lower parts of the postcentral gyrus of the dominant hemisphere are damaged, probably involving adjacent areas of the parietal lobe.

Apraxia of the trunk is characterized by loss of the ability to properly position the trunk and legs in order to stand, walk, and sit. Also designated by the term astasia-abasia. Movements in the legs, meanwhile, are preserved in full. It occurs when the parietal region is damaged in both hemispheres, often with a disruption of its connection with the visual thalamus.

Apraxia of dressing (Brown, 1941) is characterized by the loss of the ability to carry out the sequence of actions with clothing in order to dress and undress. Patients cannot correctly associate items of clothing with parts of their body. When putting on a shirt, for example, the patient tries to pull it over his head, but at the same time sticks his left hand into the right sleeve. Or puts on a shirt buttoned back. He performs similar actions with other clothes, shoes, and hats. It is observed with damage to the angular gyrus of the parietal lobe of the left hemisphere.

Agraphia (from the Greek a - particle of negation, grapho - to write) is a violation of the ability to write. Apractical agraphia is a variant of ideatorial apraxia, when the idea of ​​the movements necessary for writing is lost. Agraphia constructive (Kleist, 1934) is manifested by the inability to write legibly from memory or from a model. Motor agraphia is associated with paralysis. Pure agraphia is caused by damage to the posterior parts of the second frontal gyrus of the dominant hemisphere.

The neuropsychology of apraxia is presented somewhat differently in the works of A. R. Luria (1974).

The author distinguishes between these types of apraxia.

1. Kinetic or afferent apraxia is characterized by a main defect in the form of a violation of proprioceptive kinesthetic afferentation. The patients' movements are undifferentiated and poorly controlled. When shaking hands, the “shovel hand” symptom is observed, when the hand is presented straight, as if not ready for this action. Writing movements are impaired, various hand postures are not reproduced (signs of approval, disagreement, etc.) - postural apraxia. Actions without objects are difficult: the patient cannot show, for example, how to pour water into a glass. Visual control somewhat improves the execution of actions. The disorder occurs when the parietal lobe is damaged near the lower parts of the postcentral gyrus. When affected on the left, the disorder is bilateral; on the right, it affects only the left hand.

2. Spatial apraxia is based on a violation of the visual-spatial afferentation of movements. Typical symptoms include postural apraxia and difficulty performing spatially oriented movements. There is no clear difference when performing movements with open and closed eyes.

3. Constructive apraxia (Krol, 1933; Kleist, 1934) is characterized by impairments in drawing and constructing figures from parts. Patients cannot draw simple geometric figures, objects, animals and humans from memory in a recognizable or accurate manner. Drawing from memory is especially difficult. Patients incorrectly select a place on a sheet of paper to draw according to the pattern. In this case, a symptom of inclusion is revealed - they place their drawing close to the sample or superimpose it on the latter. The left field of space is often ignored. When constructing (from sticks, cubes), patients cannot put together a certain figure according to the proposed model. The violation of copying is especially noticeable when it comes to unnamed (“non-verbal”) figures. The last technique is used to identify hidden constructive apraxia. The disorder occurs when the angular gyrus of both the left and right hemispheres is damaged. In right-handers, impairments with left-sided damage are more pronounced. According to other sources, the lesion is located in the inferior parietal and parieto-occipital regions of the dominant hemisphere.

4. Kinetic apraxia is characterized by a violation of the sequence of motor acts. Motor perseverations are typical, patients seem to get stuck on performing some movement, being unable to move on to the next one. Actions with objects, drawing, writing, and performing graphic tests, especially those associated with series of movements, are impaired—dynamic apraxia.

5. Regulatory apraxia is manifested by a violation of voluntary control of motor acts, including speech. As a result, expedient actions are replaced by stereotyped ones. Some motor programs—systemic perseverations—can be reproduced mechanically in their entirety. Particular difficulties arise for patients in situations of changing the program of action. The disorder is associated with a focus of damage in the convexity prefrontal cortex, especially on the left. Severe damage is manifested by echopraxia.

In the literature there is a description of other variants of praxis violation; we will indicate some of them.

Akinetic apraxia is manifested by the loss of the ability to perform voluntary actions due to a lack of motor initiative and motivation to be active.

Ocular apraxia is characterized by the loss of the ability to fixate the gaze on a specific object. At the same time, the patients’ gaze continuously wanders, it constantly moves from one object to another.

Amnestic apraxia is manifested by the loss of the ability to perform sequential actions at the request of the outside. It is due to the fact that patients forget about what next action they have to perform.

Limb apraxia is characterized by loss of conscious control over arm movements. It manifests itself: 1) by movements of the wrong hand that should perform the action, 2) by incorrect movements of the correctly chosen hand, and 3) by correct movements of the hands in the wrong sequence.

Perseveratory apraxia is manifested by the loss of the ability to act purposefully due to motor perseverations. Occurs when the frontal cortex of the brain is damaged. Apraktoagnosia (from the Greek apractos - useless, inactive, a - particle of negation, gnosis - knowledge, cognition) is characterized by a combination of apraxia, primarily constructive, and agnosia. Two variants of the disorder have been described. The first is Hecaen's syndrome (Hecaen, 1956). Left-sided spatial agnosia, visual-constructive disorders, apraxia of dressing, disturbance of topographical ideas and concepts, hemisomatognosia, dyslexia and acalculia are observed.

The disorder occurs when the lesion is localized in the right hemisphere (supramarginal and angular gyri, posterior part of the superior temporal gyrus). The second option is Zangwill syndrome (Zangwill, 1950). This disorder is characterized by the following symptoms: 1) ignoring the left half of visual space, that is, unilateral spatial agnosia, 2) constructive apraxia, 3) impaired topographic memory and spatial disorientation, 4) apraxia of dressing, and 5) oculomotor disorders and defects in visual coordination. The disorder occurs when the right hemisphere of the brain is damaged.

Alexia (from Greek a - prefix of negation, lexis - word, speech) - loss of the ability to read. The disorder may be associated with the following factors: inability to distinguish letters - literal alexia, inability to distinguish syllables - asyllabia, and inability to distinguish words - verbal alexia. The dynamics of the disorder are characterized by the following sequence of violations. The lesion is localized in the basal cortex of the occipital lobe of the dominant hemisphere. In some cases, the damage extends to the temporal cortex of the brain (Smirnov, 1962). The ability to write is lost. With pure alexia, patients cannot read what they themselves have written.

Alalia (from Greek a - prefix of negation, lalia - speech) or aphemia - loss of the ability to speak. Described by Delius (1757). Depending on whether expressive or impressive speech suffers, motor and sensory alalia are distinguished. Observed in childhood. It is caused by underdevelopment of the speech areas of the brain, their pre- or early postnatal damage. When motor alalia is impaired or absent, active speech may not be affected by understanding the speech of others. Sensory alalia is characterized by the timely appearance of speech activity and misunderstanding of the speech of others. Some authors use the term to designate functional speech disorders, preferring to define organic ones with the term “aphasia.” The inability to speak due to spasms of the speech muscles is called aphtensia.

Acalculia or dyscalculia (from Latin a - prefix of negation, calculo - to count; Greek dys - prefix meaning negation, separation, division). Described by SEHenschen (1919). Characteristic are counting disorders, especially those associated with passing through tens, the inability to grasp or loss of understanding of the place value structure of numbers. There are very local violations when the patient, for example, adds numbers correctly, but does not know how to subtract. The disorder is explained by a violation of simultaneous synthesis (Luria, 1962), which occurs when the parieto-occipital region of the dominant hemisphere is damaged. In rare primary acalculia (Berger, 1926), the disorder is not associated with a disorder of other higher cortical functions. With secondary acalculia, the disorder occurs in combination with a general decrease in memory, the phenomena of aphasia and perseveration.

Azaphia or azathololalia (from the Greek a - prefix of negation, saphes - clear) - slurred, indistinct speech. A rarely used synonym for motor aphasia and dysarthria. Akatamasesia (from the Greek a - prefix of negation, katamothesis - complete knowledge) is a complete inability to understand spoken language. Caused by sensory aphasia, it is also observed in acute psychotic states.

Aprosody or disprosody (from the Greek a, dys - prefixes of negation, prosodikos - relating to stress) is the inability or loss of the ability to master the prosodic characteristics of speech, such as stress, tonality, volume, pauses. Usually accompanies aphasia and in this case is associated with pathology of the frontal cortex of the brain, presumably the subdominant hemisphere. It can also occur with other disorders, such as affective ones.

Apsithyria (from the Greek a - prefix of negation, psithyros - whisper) - the inability or loss of the ability to speak in a whisper. Probably one of the manifestations of aprosody. More often observed in hysteria, in this case it is combined with aphonia.

Aphonia (from Greek a - prefix of negation, phonema - sound) - the absence of sonorous speech while maintaining whispered speech. It is observed with organic damage to the brain, larynx, psychogenicity (usually hysteria). Loss or weakening of voice power is associated with incomplete closure of the vocal cords when their tension is weak. With functional aphonia, a loud voice may suddenly appear during affect.

Afrasia (from the Greek a phrasis - figure of speech, expression) is a persistent or transient loss of speech. In hysteria it manifests itself as psychogenic mutism.

Aschematism (from the Greek a - prefix of negation, schema - image, appearance, form) - loss of the ability to recognize objects depicted in pictures. Recognition of the objects themselves is not impaired (Gurevich, 1940). It is observed when the lower parietal region of the brain is damaged.

Dyslogy (from the Greek dis - prefix of negation, separation, logos - word, concept, doctrine) - the inability or loss of the ability to verbally express one’s thoughts. The ability to express one's thoughts in writing may not be impaired.

In childhood psychopathology, delayed development of skills is more common. This is especially true for school skills. We will indicate some of them that are not related to mental retardation, verified focal pathology of the brain, sensory and emotional disorders, social deprivation and originating from the early stages of child development. It is assumed that such deviations are caused by biological dysfunction and occur when cognitive information processing is impaired. As in cases of other pathologies, they are more common in boys.

Often, disorders can persist even in adult patients. It should be noted that it is difficult to distinguish the actual delay in the development of school skills from cultural, individual and age-related developmental characteristics, as well as those associated with other pathologies, such as attention deficit and hyperactivity. Currently, developmental disorders of reading, spelling, counting skills and, in addition, motor clumsiness have been better studied, although there may be other disorders, as well as their combinations.

1. Specific reading disorder is a clinically significant disorder in the development of reading skills, resulting in decreased performance in all disciplines related to reading in one way or another, emotional and behavioral problems. The essence of the disorder is the difficulty of distinguishing between the letters of printed and handwritten texts, that is, agnosia of writing signs. In the early stages of alphabetic learning, there may be difficulty in reciting the alphabet and categorizing sounds.

Later, the following violations of oral reading are revealed: 1) omissions, replacements, distortions or additions of words or their parts; 2) slow reading pace; 3) attempts to start reading again, long hesitations, loss of space in the text, inaccuracies in expressions; 4) rearrangement of letters and syllables in words, as well as words in sentences; mirror or reverse reading. Understanding of the meaning of what is being read is impaired. For example, the inability to remember facts from what was read, to draw conclusions about its content, the tendency to answer questions about what was read using general knowledge rather than information from the text.

At a later age, misunderstanding of what is read comes to the fore. Specific violations of reading skills are usually preceded by a disorder of speech development, problems with categorization of sounds, rhyming, possibly, defects in distinguishing letters and speech sounds, auditory sequential memory, and auditory association. Synonyms for the term: developmental dyslexia, specific reading delay, backward reading, spelling disorder combined with reading disorder.

2. Specific spelling disorder is a clinically significant impairment in reading comprehension. The ability to reversely translate oral speech into written language is also impaired. Phonological errors in writing are not associated with differences in the rules of spelling and pronunciation of words. Illegible handwriting does not apply here. Some authors talk about disorders of phonological awareness. Reading skills usually develop normally. Spelling disorder has been poorly studied in terms of its antecedents, dynamics, correlates, and outcome.

3. Specific numeracy disorder is a clinically significant disorder in the development of numeracy skills relating to basic arithmetic operations in written and oral counting. Higher math skills can be developed much more successfully. The formation of reading and spelling skills is not impaired. The disorder has been poorly studied, and it has been suggested that visuospatial and visual-perceptual skills may be impaired. Arithmetic difficulties may include:

• Uncertainty of the concepts underlying account operations;
• Lack of understanding of mathematical terms or symbols;
• Failure to recognize number signs;
• Difficulty performing standard counting operations;
• Difficulty understanding which numbers to use in counting operations;
• Difficulty mastering the order of numbers, decimals and counting signs;
• Poor spatial organization of arithmetic calculations;
• Inability to master the multiplication tables.

Synonyms for the term: Gerstmann-Schilder developmental syndrome, developmental specific numeracy disorder, developmental acalculia.

4. Specific motor development disorder is a clinically significant impairment in the development of motor coordination, motor clumsiness or retardation, usually combined with impaired performance in performing visuospatial cognitive tasks. Both gross and especially fine frontal motor coordination of movements, noticeable from early childhood, suffers. At the same time, there may be choreiform hyperkinesis, mirror movements, articulation disorders, increased, decreased or asymmetrical tendon reflexes and other mild neurological signs.

Children slowly learn to walk, run, jump, stand on one leg, go up and down stairs, walk on an inclined surface, etc. It is difficult for them to learn to fasten buttons, tie shoelaces, throw and catch a ball, throw stones and hit a target with them. .
They are more likely than their peers to drop things, stumble, hit themselves, have illegible handwriting, are worse at drawing, and complete tasks with composite picture puzzles, construction toys, understanding and drawing maps. In many patients, motor coordination problems persist into later life. Synonyms of the term: childhood clumsiness syndrome, developmental dyspraxia. Back to contents

Signs and symptoms

The main symptom of apraxia is the inability of a person to perform movements in the absence of any physical paralysis. The commands to move are clear, but cannot be executed. When the movement begins, it is usually very clumsy, uncontrollable and inappropriate. In some cases, movement may occur unintentionally. Apraxia is sometimes accompanied by a person's loss of ability to understand or use words (aphasia).

Certain types of apraxia are characterized by the inability to perform certain movements on command. For example, with apraxia of the cervicofacial region, a sick person cannot cough, whistle, lick his lips or wink when asked to do so. With the constructional type of the disease, a person cannot reproduce simple patterns or copy simple drawings.

Etiology, risk factors

Manifestations of apraxia are associated with damage to the parietal, frontal lobes of the cerebral cortex, and corpus callosum. The following pathologies can provoke this condition:

• dementia arising from chronic lack of blood circulation;
• traumatic brain injuries;
• encephalitis;
• Alzheimer's disease;
• brain tumors;
• Parkinson's disease.

If you have one of the diseases described above, you need to regularly monitor your health over time.

Diagnosis of the pathological condition

Who diagnoses the disease? To assess speech development, an audiologist is involved, who must assess the condition of the hearing organs and exclude this factor as the cause of the disorder. The speech therapist checks the characteristics of oral speech, motor skills, and melody. Oral-motor assessment criteria:

• checking the muscle tone of the speech apparatus;
• development of coordination;
• orderliness of muscle movements.

The specialist observes the patient while performing speech therapy tasks and in functional situations. The test of melody lies in the ability to change intonation and pauses. An important criterion for speech development is the patient’s ability to conduct a dialogue, to the extent that what he says is understandable to others.

Making a diagnosis begins with studying the medical history and analyzing the patient’s complaints. Primary attention is paid to the articulation of the eyelids, the ability to perform simple everyday actions (for example, unfastening and fastening buttons). Already visually, a specialist can guess the specifics of the disorder. Apraxia is confirmed instrumentally after hardware diagnostics of the brain.

Gesture prompts

Another approach is to use visual gesture cues. The parent or therapist touches their mouth when they make a certain sound. For example, we can bring our index finger to our lips and move it away when we say the sound "p". The prompt draws the child's attention to how the lips form a certain sound.

We will use more than one clue when we say a whole word to show the difference between the sounds in a word. The combination of visual and verbal cues helps the child focus, understand and pronounce the word better.

This type of prompting can be especially helpful for children with autism, who often tend to be visual learners. However, this method requires that the child can pay attention to the cues and imitate them.

What does the doctor do?

If apraxia is suspected, the doctor will first take a medical history. To do this, he often collects information from relatives and nurses (external medical history), since many patients additionally suffer from a speech disorder (aphasia) and are therefore unable to provide information themselves. It is important for the doctor, for example, to observe that the patient cannot express his wishes with gestures, tries to eat soup with a fork, or pushes toothpaste out of a closed toothpaste tube.

Using various examinations and tests, the doctor can then test specific activities and movements that are often disrupted during apraxia. For example, he may ask the patient to imitate simple hand movements, finger positions, or gestures. He may also verbally ask the patient for certain gestures (for example, “Show me how to hit!”).

Objects are also used for testing: it is suggested to cut paper with scissors, put on glasses, open the latch, etc. For example, to identify buccal-lingual apraxia, the doctor may ask the patient to whistle, click his tongue, suck on a straw, or alternately puff out his cheeks.

Description

Apraxia is understood as a motor impairment that cannot be explained by an underlying motor disability: there is no paralysis or incoordination. However, victims are unable to make voluntary, purposeful movements or handle objects (such as cutlery or tools).

Apraxia usually results from damage to the left side of the brain (for example, from a stroke). It usually affects both sides of the body and, in most cases, is accompanied by a simultaneous speech disorder (aphasia). Often apraxia is accompanied by paralysis of the right side of the body, so that the effects of dysfunction can only be seen on the left (still mobile) side.

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Clinical picture

The disease is characterized by a number of signs at different ages; the diagnosis is made after a comprehensive examination. The main symptoms of apraxia in children:

• lack of babbling;
• the child begins to speak late;
• limited reproduction of sounds with difficulty connecting them;
• replacing phonemes or omitting difficult ones to pronounce.

After the speech formation period, errors in sequence may occur less frequently. Imitation is difficult for a child, but in this case it is easier to understand him. Short phrases are easier for him. As with stuttering, anxiety makes communication difficult. As a result, a complex of deviations leads to delayed language development, memory impairment, and difficulties with fine motor skills. Other problems include oral sensitivity, which may cause your child to not like brushing their teeth or chewing crunchy foods. Apraxia also leads to difficulties in mastering written grammar and poor reading.

In speech therapy, this term is used in relation to aphasia, cortical dysarthria, and motor alalia. The deviation may be general in nature, affecting only oral, articulatory or spatial characteristics.

General apraxia is characterized by the inability to coordinate hand movements and, as a result, the inability to use objects for their functional purposes. In the oral form of the pathology, the muscles innervating the speech organs do not move. Apraxia of speech is manifested by incorrect reproduction of sounds: there are various errors in their pronunciation and problems with phonemic perception. In the monotype, apraxia is rare; it is characterized by a mixture of manifestations.

Differences in the course of pathology in adults and children

The child makes more mistakes when speaking, but the neurological symptoms are not clearly expressed. At the same time, the causes of apraxia in older people are injuries and brain tumors, circulatory disorders, which casts doubt on the diagnosis itself. If we are talking about a congenital pathology, doctors assume its hereditary nature, and a theory is developed about an anomaly in chromosomes and a violation of metabolic processes.

Apraxia of speech is considered a motor speech disorder.

What other symptoms should you pay attention to? Patients with apraxia have a stiff gait and small steps; it is difficult for them to perform ordinary daily activities: getting dressed, making the bed, combing their hair, etc. This is not necessarily a feature of apraxia, but consultation with specialists is necessary

Classification of apraxia by type of reaction to internal and external stimuli (A. R. Luria):

• kinesthetic form - lack of connection between body position and movement; for example, due to the fact that the patient does not feel the position of his fingers, he cannot show how to pour tea;
• kinetic is the absence of automation of actions, pauses occur, human movements are angular;
• the spatial view is associated with a violation of orientation, its subtype is constructive;
• the regulatory form consists of unconscious, uncontrolled actions; it is difficult for a person to coordinate them.

Psychoneurologist G. Lipmann also distinguished ideomotor and ideational forms of apraxia. With the ideomotor type, the patient understands what needs to be done, but skips some actions or does not complete the process. The ideational type is more often found in combination with the regulatory one and is characterized by the fact that a person cannot remember the meaning of performing an action, and subsequently does not control the correctness of his actions. Ideational apraxia differs from ideomotor apraxia in that the patient retains the ability to imitate, which greatly facilitates communication.

Separately, speech therapy deals with eyelid apraxia, the symptoms of which are difficulty opening and closing the eyes. There is no infectious cause for this condition, blepharospasm or damage to the facial nerve. The pathology manifests itself in a one-sided way: it is difficult to open or close the eyelids. As a rule, complications are associated specifically with opening the eyes, so the patient has to wrinkle his forehead, throw back his head, or pull up part of the eyelid with his fingers.

Causes

Apraxia results from a defect in the brain pathways that contain the memory of learned movement patterns. The damage may result from certain metabolic, neurological, or other disorders that affect the brain, especially the frontal lobe (inferior parietal lobe) of the left hemisphere of the brain. This region retains complex three-dimensional representations of previously learned patterns and movements. Patients with apraxia are unable to regain these stored skilled movement patterns.

Oculomotor apraxia is a dominant genetic feature. The gene for this condition was found on chromosome 2p13. Each chromosome has a short arm, designated "p", and a long arm, designated "q". The chromosomes are further divided into many bands, which are numbered. For example, "chromosome 2p13" refers to band 13 on the short arm of chromosome 2. The numbered bands indicate the location of the thousands of genes present on each chromosome.

Genetic diseases are determined by two genes, one from the father and the other from the mother.

Dominant genetic disorders occur when only one copy of the abnormal gene is needed to cause the disease. The abnormal gene may be inherited from either parent or may be the result of a new mutation (gene change) in the affected person. The risk of passing the abnormal gene from the affected parent to the offspring is 50% for each pregnancy, regardless of the sex of the child.

Tissue or cellular damage (lesion) to other specific parts of the brain, whether from stroke or injury, tumors or dementia, can also cause apraxia. These other locations include the so-called supplementary motor area (premotor cortex) or corpus callosum.

If apraxia is the result of a stroke, it usually improves within a few weeks. Some cases of apraxia are congenital. When a child is born with apraxia, it is usually the result of a malformation of the central nervous system. On the other hand, people with declining mental functioning (degenerative dementia) may also develop apraxia.

People with a condition of declining mental functioning (degenerative dementia) may also develop apraxia.

Exclusion of other diseases (differential diagnosis)

To make an accurate diagnosis, the doctor must rule out other conditions that may cause symptoms such as apraxia. These include, for example, paralysis of movements of the mouth, face, head and trunk, ataxia (impaired coordination of movements), neglect (impaired perception as a result of a stroke, in which half of the environment or one’s own body is not perceived). Also, for example, dementia and speech comprehension disorder must be excluded. For this purpose, appropriate tests and studies are carried out.

Building a Basic Dictionary

With this and other approaches, it is very important to always start with the basic vocabulary. This is the name of 10-20 words that are chosen by parents and a specialist. The main dictionary should include those words that are most often used in everyday speech (for example, “mom” and “dad”), have a special meaning for the child (for example, “train”, if the child really loves trains), and indicate the most common actions (for example, “eat”, “go”, etc.) and which are easiest to imitate (depending on the child’s skills).

Together with a specialist, the child will practice pronouncing these words in structured lessons. At home, you will practice saying these words in natural situations when the child encounters these people, objects or actions throughout the day.

As with any new skill, constant repetition and practice is the best way to improve results and help your child become more independent. At first, your child may need help pronouncing the word. Then gradually she learns to say it on her own without your prompting. After this we can enter a new word to form a phrase and so on.

Typically, therapy for apraxia is a combination of all of these approaches.

Visual support and speech generating devices

Your speech-language pathologist may recommend using an assistive communication method, such as visual aids (picture cues) or a tablet with voice-generating software. We know from experience that this approach seems wrong to many parents. They may worry that support through pictures or a speech-generating device will begin to replace the child's speech and stunt its development. The good news is that research shows just the opposite.

Alternative communication methods encourage the development of oral language. This may be because they provide the child with opportunities to interact with others while he works on his language skills. In our practice, we often see how the connection between a picture and a word helps nonverbal and minimally verbal children better understand and use words.

Principles of treatment

For therapy to be successful, classes should take place up to 3-5 times a week. Individual lessons are preferable to group exercises, especially at the initial stage. Subsequently, subject to positive dynamics, tactics can be changed. Parents of a child with apraxia must be patient and actively participate in the development program. A favorable family environment facilitates the treatment process.

Therapy for apraxia should begin with eliminating the cause of the pathology, that is, treating the underlying disease.

In addition to taking medications according to an individual regimen for each patient, physiotherapeutic methods help improve the quality of life. If we are talking about the oral form, classes with a speech therapist are necessary. The prognosis is favorable, of course, subject to systematic treatment and exercise. Close relatives should be patient with the manifestations of the disease and the patient’s lifestyle, and help him in everyday life.

There are no special recommendations for preventing the disease. They are common. This includes a healthy lifestyle, a balanced and rational diet, and timely examination by a doctor in the presence of complaints and chronic infections. In case of health problems due to vascular problems, it is necessary to monitor blood pressure levels.

Prevention

Preventive measures that effectively help prevent this problem have also not been developed. Despite this, there are a number of recommendations that significantly reduce the risk of the occurrence and development of movement disorders:

• giving up bad habits and alcohol;
• make regular walks in the fresh air and exercise;
• regulate your diet;
• eat a balanced diet, consume only healthy foods and in quantities necessary for the body;
• visit the hospital regularly and undergo a full examination;
• Monitor your blood pressure and if surges are observed, it is better to consult a doctor about this problem.

Apraxia is a rather complex and serious disease, as a result of which a person loses the motor function of certain organs or parts of the body, and it is difficult for him to carry out even the most basic manipulations with objects.

People suffering from this disease are dependent on society, in particular on family and friends, since they are simply unable to perform certain operations. Be healthy!

Possible consequences and complications

The lack of treatment aimed at restoring and improving the quality of a child’s speech threatens the development of the following complications and negative consequences:

• violation of the child’s socialization;
• progression of dysfunction of the facial muscles, which is responsible for the mobility of the lower jaw, lips and tongue (this complication will only aggravate the existing signs of oral apraxia);
• the need to receive individual education due to the lack of ability to reproduce words and correctly construct sentences;
• retardation in physical and mental development;
• lack of communication skills with peers and other people around them;
• the emergence of a tendency to aggression, the emergence of outbursts of rage and signs of an unstable psycho-emotional state due to limited abilities to express thoughts;
• the development of complexes and self-doubt that appear in a child due to incorrect reproduction of words and sounds, as well as ridicule from other children;
• preservation of speech apparatus defects, which remain with children at all stages of their growing up, significantly reducing their quality of life.

Apraxia is a severe neurological disorder that develops due to focal lesions in individual areas of the central nervous system. In speech therapy, this disease is characterized by oral apraxia, the symptoms of which are manifested by impaired mobility of the facial muscle tissues responsible for the synchronous interaction of the lips, lower jaw and tongue.

The main symptom of this disease is that the child completely or partially lacks the ability to reproduce most sounds and words. An audiologist and speech therapist are involved in diagnosing pathology.