From the Guidelines
Apraxia is a neurological disorder characterized by the inability to perform purposeful movements, despite having the physical ability and desire to do so, and is often caused by damage to specific areas of the brain responsible for planning and coordinating movements. This condition can manifest in various forms, including limb apraxia, verbal apraxia, and ideational apraxia, each affecting different aspects of movement and communication. According to the American Heart Association/American Stroke Association guidelines for adult stroke rehabilitation and recovery 1, interventions for motor speech disorders, such as apraxia of speech, should be individually tailored and may include behavioral techniques and strategies that target physiological support for speech, including respiration, phonation, articulation, and resonance.
Some key aspects of apraxia and its management include:
- The importance of early intervention to maximize recovery and develop effective compensatory strategies
- The use of speech therapy for verbal apraxia or occupational therapy for limb apraxia, focusing on repetitive practice of movements and alternative communication strategies
- The need for environmental modifications, including listener education, to improve communication effectiveness
- The potential benefits of augmentative and alternative communication devices and modalities to supplement speech
- The consideration of activities to facilitate social participation and promote psychosocial well-being
As noted in a comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient 1, motor speech evaluations are crucial in establishing the presence and severity of apraxia of speech and dysarthria, and should assess the integrity of each component of the motor speech system, including respiration, phonation, resonance, articulation, prosody, and overall intelligibility. Treatment should prioritize a multidisciplinary approach, incorporating speech therapy, occupational therapy, and environmental modifications to improve communication effectiveness and promote psychosocial well-being.
From the Research
Definition of Apraxia
- Apraxia is defined as the inability to perform skilled or learned movements, which is essential for daily living 2.
- It can be further classified into subtypes such as ideomotor, ideational, and limb-kinetic apraxia 2.
Prevalence and Effects of Apraxia
- Apraxia is found in a variety of highly prevalent neurological disorders, including dementia, stroke, and Parkinsonism 2.
- It affects 20% of right brain-damaged patients and 50% of left brain-damaged patients 3.
- Apraxia negatively affects quality of life and reduces patients' independence 2, 3.
Treatment and Rehabilitation of Apraxia
- Recognition and treatment of apraxia are critical, and motor training and noninvasive brain stimulation may be used as treatment 2.
- Physiotherapy and speech therapy interventions have been shown to be effective in improving outcomes for patients with apraxia 3, 4, 5, 6.
- Articulatory kinematic approaches and metrical pacing therapy are prominent treatments for apraxia of speech 4, 6.
- Sound production treatment and metrical pacing therapy have been compared, and both have been shown to be effective in improving whole word correctness and intelligibility 6.