What is the treatment for apraxia?

Treatment for Apraxia

Speech and language therapy is the primary treatment for apraxia and should be provided early and intensively to improve functional communication. 1

Types of Apraxia and Assessment

Apraxia is a motor planning disorder that can affect speech (apraxia of speech) or limb movements (limb apraxia). Before initiating treatment, proper assessment is crucial:

• For apraxia of speech: Referral to a Speech-Language Pathologist (SLP) for comprehensive assessment of comprehension, speaking, reading, writing, gesturing, and conversation 1
• For limb apraxia: Assessment of ability to perform activities of daily living (ADL) 2

Treatment Approach for Apraxia of Speech

Timing and Intensity

• Early intervention is critical - therapy should begin within the first 4 weeks post-stroke to maximize recovery 1
• Intensive therapy recommended:
  • Acute phase (first 6 weeks): 30-45 minutes, 2-3 days per week 1
  • First few months: At least 45 minutes of direct language therapy, 5 days per week 1
  • Chronic phase (>6 months): At least 10 hours/week of therapist-led therapy for 3 weeks, plus 5+ hours/week of self-managed training 1

Therapeutic Techniques

1. Speech and language therapy focusing on:

   • Production and comprehension of words, sentences, and discourse 1
   • Conversational treatment and constraint-induced language therapy 1
   • Reading, writing, and general expressive language 1

2. Alternative communication strategies:

   • Use of gestures, drawing, writing 1
   • Augmentative and alternative communication devices 1
   • Assistive technology (tablets, computer-guided therapies) 1

3. Delivery methods:

   • Individual therapy sessions with SLP 1
   • Group therapy and conversation groups 1
   • Computerized treatment to supplement therapist-led sessions 1

Treatment Approach for Limb Apraxia

For patients with limb apraxia affecting daily activities, strategy training is recommended:

• Strategy training program: A standardized occupational therapy approach teaching compensatory strategies to improve ADL performance 2
• Implementation:
  • 3 sessions of 30 minutes/week for 8 weeks
  • Focus on visual feedback approach
  • Training in specific ADLs (e.g., brushing teeth, dressing)
  • Three-step process: initiation (action planning), execution, and control (assessment) 2

Communication Partner Training

An essential component of apraxia treatment includes:

• Training for family members and caregivers in supported conversation techniques 1
• Education about apraxia and communication strategies 1
• Environmental adaptations to reduce communication barriers 1

Monitoring and Follow-up

• Regular reassessment of goals and treatment plans 1
• For chronic apraxia (>6 months), continued evaluation for additional therapy 1
• After the first four months, review to determine suitability for further treatment 1

Common Pitfalls and Considerations

• Misdiagnosis: Apraxia can co-occur with aphasia and dysarthria, making differential diagnosis challenging 3
• Limited evidence: Many apraxia treatments have limited empirical support and lack replication 4
• Co-existing conditions: Children with apraxia often have other functional problems including attention issues, vestibular function problems, and fine motor difficulties 5
• Sensorimotor approach: Consider tactile or kinesthetic methods and slowed speech techniques to facilitate processing of peripheral sensation 6

By implementing these evidence-based approaches with appropriate intensity and timing, patients with apraxia can achieve improved functional communication and independence in daily activities.