LECTURA Apraxia.PDF
- 1. Gillen, Glen. Stroke Rehabilitation: A Function-Based Approach. 4th ed. St. Louis: Elsevier, 2016. LaPointe, Leonard, ed. Aphasia and Related Neurogenic Language Disorders. 4th ed. New York: Thieme, 2011. Monaghan, Gerri, and Brian Monaghan. When a Loved One Falls Ill: How to Be an Effective Patient Advocate. New York: Workman, 2011. Pitts, Bill, and Sue Sheridan. Coping With Aphasia. 1st ed. Put It In Ink, 2009. PERIODICALS Nobis-Bosch, R., et al. ‘‘Supervised Home Training of Dia- logue Skills in Chronic Aphasia: A Randomized Paral- lel Group Study.’’ Journal of Speech, Language, and Hearing Research 54, no. 4 (August 2011): 1118-36. Purdy, Mary, and Julie A. Van Dyke. ‘‘Multimodal Communication Training in Aphasia: A Pilot Study.’’ Journal of Medical Speech-Language Pathology 19, no. 3 (September 2011): 45-53. Schlaug, G., et al. ‘‘From Singing to Speaking: Facilitating Recovery from Nonfluent Aphasia.’’ Future Neurology 5, no. 5 (September 2010): 657-65. ORGANIZATIONS National Institute of Neurological Disorders and Stroke (NINDS), PO Box 5801, Bethesda, MD, 20824, United States, (301) 496-5751, (800) 352-9424, http:// www.ninds.nih.gov. American Speech-Language-Hearing Association (ASHA), 2200 Research Boulevard, Rockville, MD, 20850-3289, United States, (301) 296-5700, (800) 498-2071, Fax: (301) 296-8580, actioncenter@asha.org, http://www.asha.org. National Aphasia Association, PO Box 87, Scarsdale, NY, 10583, United States, (212) 267-2814, (800) 922-4622, Fax: (212) 267-2812, naa@aphasia.org, http:// www.aphasia.org. Brain Injury Association of America, 1608 Spring Hill Road, Suite 110, Vienna, VA, 22182, United States, (703) 761-0750, Fax: (703) 761-0755, http://www. biausa.org. Brain Injury Resource Center, PO Box 84151, Seattle, WA, 98124-5451 , United States, (206) 621-8558, brain @headinjury.com, http://www.headinjury.com. Family Caregiver Alliance, 235 Montgomery Street, Suite 950, San Francisco, CA, 94104, United States, (415) 434-3388, (800) 445-8106, http://www.caregiver.org. Head Trauma Support Project, Inc., PO Box 215666, Sacramento, CA, 95821, United States, (916) 568-6660, info@headtraumasacramento.org, http:// www.headtraumasacramento.org. National Institute on Deafness and Other Communication Disorders (NIDCD), 31 Center Drive, MSC 2320, Bethesda, MD, 20892-2320, United States, (301) 827-8183, (800) 241-1044, Fax: (301) 402-0018, nidcdinfo@nidcd.nih.gov, http://www.nidcd.nih.gov/. National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, MD, 20892, United States, (301) 496-4000, NIHinfo@od.nih.gov, https://www.nih.gov. National Stroke Association, 9707 East Easter Lane, Suite B, Centennial, CO, 80112, United States, (800) STROKES (787-6537), Fax: (303) 649-1328, info @stroke.org, http://www.stroke.org. US National Library of Medicine, 8600 Rockville Pike, Bethesda, MD, 20894, United States, (301) 594-5983, (888) 346-3656, Fax: (301) 496-2809, custserv@nlm. nih.gov, http://www.nlm.nih.gov/. Julia Barrett Revised by Laura Jean Cataldo RN, EdD Apolipoprotein B deficiency see Bassen- Kornzweig syndrome. Apraxia Definition Apraxia is neurological condition characterized by loss of the ability to perform activities that a person is physically able and willing to do. Demographics From 500,000 to 750,000 people need to be hos- pitalized each year for head injuries according to the American Medical Association (AMA). Men between Lesions in this area are associated with Apraxia Supramarginal gyrus The region of the brain affected by apraxia. 140 GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS, 3R D EDITION Apraxia COPYRIGHT 2017 Gale, A Cengage Company WCN 02-200-210
- 2. 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. Description 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. Strokes can also be a cause of apraxia. 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 forms of this condition. Further- more, a milder form of apraxia is called dyspraxia. Causes and symptoms 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. Types of apraxia 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 cough- ing, 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, wit- ting, speaking, and understanding when others speak. Post-apraxia changes A person with apraxia could experience frustra- tion about difficulty communicating or trouble per- forming tasks. In some cases, the condition could affect the person’s ability to live independently. Diagnosis Diagnosis of apraxia could begin with testing of its underlying cause. Testing for conditions such as 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 physi- cian takes a family history. Head trauma that could cause apraxia is first treated in the emergency room. Other diagnostic treatment is related to identify- ing 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. GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS, 3R D EDITION 141 Apraxia COPYRIGHT 2017 Gale, A Cengage Company WCN 02-200-210
- 3. Assessment for speech apraxia in children includes a hearing evaluation to determine if diffi- culty in speaking is related to a hearing loss. If the condition appears related to apraxia, a speech-lan- guage 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 such as 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. Treatment The treatment for apraxia usually involves reha- bilitation through speech-language therapy, physical therapy, or occupational therapy. In addition, treat- ment, such as chemotherapy, is administered for the condition that caused the apraxia. 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 Speech-language therapy focuses on helping the patients learn or regain communication skills. Thera- pists 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 com- munication. These alternatives range from gesturing to using a portable computer that writes and produces speech, according to ASHA. Occupational and physical therapies 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. Alternative treatment Most alternative treatments target Alzheimer’s dis- ease and other conditions that cause apraxia. Herbal remedies thought to help people with Alzheimer’s include ginkgo biloba, a plant extract. However, organ- izations including the Alzheimer’s Association caution that the effectiveness and safety of this herbal remedy has not been evaluated by the US 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 combi- nation with aspirin and blood-thinning medications. Prognosis 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. Prevention The methods of preventing apraxia focus on pre- venting 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, but a person can reduce the risk by not smok- ing, by exercising, and by eating a diet based on the American Heart Association guidelines. KEY TERMS CT scanning—Computer tomography scanning is a diagnostic imaging tool that uses x-rays sent through the body at different angles. Magnetic resonance imaging—Imaging that uses magnetic fields and radio waves instead of x-rays. The imaging data is processed by computer soft- ware to provide detailed images. MRI—Magnetic resonance imaging is a diagnostic imaging tool that utilizes an electromagnetic field and radio waves. Speech therapy—Training that aims to improve speech and language difficulties. Stroke—Loss of oxygen supply to the brain because of blocked blood vessels. A lengthy period of oxy- gen deprivation can result in permanent and severe brain damage. Vertigo—A spinning or swaying feeling of being off balance. 142 GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS, 3R D EDITION Apraxia COPYRIGHT 2017 Gale, A Cengage Company WCN 02-200-210
- 4. Head injury can be prevented by wearing a helmet when participating in activities such as sports and bicycling. Wearing a seatbelt when in a vehicle also helps reduce the risk of head injury. See also Alzheimer’s disease; Aphasia; Brain and spinal tumors; Dyspraxia; Stroke; Traumatic brain injury. Resources BOOKS Fish, Margaret. Here’s How to Treat Childhood Apraxia of Speech. San Diego: Plural Publishing, 2016. Hamaguchi, Patricia McAleer. Childhood Speech, Lan- guage, and Listening Problems: What Every Parent Should Know. 3rd ed. New Jersey: John Wiley Sons, 2010. PERIODICALS Lasker, Joanne P., et al. ‘‘Using WebCam Interactive Tech- nology to Implement Treatment for Severe Apraxia: A Case Example.’’ Journal of Medical Speech-Language Pathology 18, no. 4 (December 2010): 71-6. Youmans, G., S. R. Youmans, and A. B. Hancock. ‘‘Script Training Treatment for Adults with Apraxia of Speech.’’ American Journal of Speech-Language Pathology 20, no. 1 (February 2011): 23-37. WEBSITES ‘‘Apraxia Information Page.’’ National Institute of Neurological Disorders and Stroke. https://www.ninds. nih.gov/Disorders/All-Disorders/Apraxia-Information- Page (accessed January 2, 2017). ‘‘Apraxia of Speech in Adults.’’ American Speech Language Hearing Association. 2005. http://www.asha.org/public/ speech/disorders/ApraxiaAdults/ (accessed January 2, 2017). ‘‘Childhood Apraxia of Speech.’’ American Speech Lan- guage Hearing Association. http://www.asha.org/ Practice-Portal/Clinical-Topics/Childhood-Apraxia- of-Speech/ (accessed January 2, 2017). Chawla, Jasvinder. ‘‘Apraxia and Related Syndromes.’’ Medscape. November 25, 2015. http://www.asha.org/ public/speech/disorders/ApraxiaAdults/ (accessed January 2, 2017). Liz Swain Aprosodia see Aphasia; Dysarthria. Arachnoid cysts Definition Arachnoid cysts are sacs that are filled with cere- brospinal fluid and form in the surface region of the brain around the cranial base, or on the arachnoid membrane (one of three membranes that covers the brain and spinal cord). Description An arachnoid cyst forms when the two lipid (fatty) layers of the arachnoid membrane split apart to form a cavity. Like most membranes, the arachnoid membrane is comprised of two layers (leaflets) of lipid molecules. The hydrophilic (water attracting) region of the lipids is oriented towards an environment rich in water. The hydrophobic (water repelling) portion of the lipids will spontaneously partition away from water, in the interior of the membrane. When an arachnoid cyst forms, the two leaflets of the mem- brane split apart. Cerebrospinal fluid then fills the cavity. Arachnoid cysts can be classified according to their location and by the type of tissue making up the cyst wall (arachnoid connective tissue or glioependy- mal tissue). Cysts that are found in the area of the cerebrum and in the spinal cord tend to be composed of arachnoid tissue, while cysts found in the supra- collicular or retrocerebellar regions of the brain tend to be composed of either arachnoid connective tissue or glioependymal tissue. The expansion of arachnoid cysts may occur when pulses of cerebrospinal fluid become trapped in the cyst cavity. The increasing volume of fluid causes the cyst to grow in size. However, the exact nature of cyst growth is not yet well understood. Arachnoid cysts tend to form on the left side of the brain, where the spinal canal intersects. Typically, a cyst makes up QUESTIONS TO ASK YOUR DOCTOR Can you explain my condition to me in non- technical language? What diagnostic tests are needed for a thorough assessment? What treatment options do you recommend for me? Will I fully recover? Should I see a specialist? If so, what kind of specialist should I be referred to? Will therapy help me regain my lost abilities? What physical or psychological limitations, if any, do you foresee? GALE ENCYCLOPEDIA OF NEUROLOGICAL DISORDERS, 3R D EDITION 143 Arachnoid cysts COPYRIGHT 2017 Gale, A Cengage Company WCN 02-200-210