..."like", the
brain is giving our mouth "time to catch up" with the signal it is
sending.
WHAT IS AN APRAXIA
DISORDER?
There are two types that
involve Speech Pathologists:
ORAL -
the person has problems making voluntary movements of mouth muscles.
Example: The person
can randomly stick their tongue out at you, but if you ASK them to do
it... they can't.
VERBAL
(more common) -
the
person has problems with their ability to plan and program voluntary
movements to say sounds and words.
Example: If
you ask the person to say banana 4 times, they might say...
- ban-nana
- na-bana
- ba-bana
- bana-bana
Apraxia
can be:
Developmental
which affects children from birth.
Or...
Acquired
which can affect a person at any age, but most often affects
adults.
WHAT CAUSES IT?
Similar to
some speech disorders, SLPs are not sure what causes it. Like
adults, children can get acquired apraxia from a stroke,
tumor, or
head injury. Apraxia seems to affect more boys than girls.
Caruso & Strand (1999) compiled some common factors they looked
for
when evaluating a child who was thought to have developmental apraxia.
They suggested that apraxia may be present if:
- a certain genetic syndrome existed (ex.
Down, fragile X)
- a child had a history of neurological disease or
damage
- it was suspected in a family member
- a child showed excessive motor activity and withdrawl
- a child had gross/fine motor incoordination
- abnormal feeding patterns were observed
- abnormalities were observed during imitative play
with sounds or facial expressions
- there was a family history of a communication and/or
writing disorder or learning disabilities
They also noted that young children with this disorder might have:
- feeding problems
- little vocal play or babbling
- shown little imitation in infancy
- delays in early language
- behavioral disorders, temper tantrums, and
inflexibility in social situations
- difficulty making normal progress in speech therapy
- to say a word many times before they say it right
- more errors as word length increases
- receptive language that exceeds expressive language
WHAT DOES IT
AFFECT?
A child can be
mild
enough that they may only have one or two speech errors or
occasionally struggle with some multi-syllable words...
or...
...severe enough where
a child cannot communicate at all (only says vowel sounds) and
needs/uses another way to
communicate such as sign language or a communication board.
If a child has a motor deficit it will more than likely influence
the development of phonology and other language abilities (Caruso
& Strand, 1999). Apraxia may
or may not affect:
- vocabulary
- organization of spoken information
- grammar
- reading
- writing
- spelling
- math
- coordination
- chewing
- swallowing
WHAT DOES AN SLP DO
TO HELP?
Speech-Language
Pathologists have
a variety of approaches they use with children who have apraxia.
Different approaches focus on 4 types of cueing, such as:
- Tactile - touch, manipulation
- Auditory - hearing
- Kinesthetic - body movement
- Visual - pictures, watching mouth in mirror
Therapy should be frequent, intense, and focused. Haynes (1985)
summarized the techniques she would use from her research on apraxia.
She said she would use:
- concentrated drill (both imitative and on command) of
isolated movements of the tongue and lips
- imitation of sustained vowels and consonants
- imitation of syllables and words
- slow rate and facilitate self-monitoring
- introduce core vocabulary
- carrier phrases to provide a basis for increased
meaningful sentences
- rhythm, intonation, and stress, paired with arm and
leg movements to help a child understand speech motor sequencing
- tools that would develop and heighten perception and
awareness in a child's mouth
WHAT CAN I DO ABOUT
IT?
Shelley L. Velleman
Ph.D., CCC-SLP offers some excellent tips for what parents can do for
their child when working with them at home.
She suggests that
low-pressure
verbal activities are the most important thing parents can
do to help. Some examples are:
- songs (monkeys swinging in the tree or jumping on the
bed, Old McDonald)
- poems
- verbal routines (pat-a-cake, Willaby Walloby Woo)
- repetitive books (Brown Bear Brown Bear, Dear Zoo,
Good Night Moon)
- daily routines (prayers, social routines, pledge of
allegiance)
She encourages parents to turn everyday activities into
verbal
routines by making up poems, songs, or sayings about them:
Example: When you
are getting ready to eat dinner you can say the following words to a
tune of your choice (nursery rhymes are easiest)
Eat, eat, eat, I like to eat, I like to eat, eat, eat, eat
This example can be repeated for just about any activity: swim, bathe,
walk, run, drive, shop, play, slide, brush (hair or teeth), climb,
wave, drink, crawl, etc.
She recommends
labeling
instead of counting objects in books:
Example: When
reading a book and you come across a picture of more than one thing
(ex. 2 or more dogs).
Instead of saying "Two dogs"
Say
"Two dogs, (point to each one and say) dog, dog"
and...
Vebalizing
repetitive activities:
Example: When
setting the table you can say
Plate,
Plate, Plate, Plate, Plate, Plate
or Knife, Knife, Knife, Knife, Knife, Knife
As boring as it might sound, this is easy to do and
easy
to make fun. So
go ahead and act silly, be over dramatic, and repeat words 4-5 times or
more.
Is it overkill?... Yep
Will you feel weird?... Maybe
Will there be times that you don't want to do it?... You bet
Will it help your
child?... Absolutely
If you have seen some modern day
cartoons, they repeat things A LOT!
That is because we learn by repetition.
I don't mean to promote
specific TV shows but Dora the Explorer is excellent at doing this.
They have one song about Dora's Map.
The song has two
very short verses and then the singer says "I'm the map" 12
times straight! and the song is over.
Above all, and this is always easier said than done. Exercise as
much patience as possible. This disorder is very frustrating
for
the individual and can be for the whole family.
If you suspect that your child has apraxia, see a Speech-Language
Pathologist right away. They will be able to discuss your options
including the possibility of using sign language and/or a communication
board.
RESOURCES WE LIKE
Apraxia-Kids.org
National Institute of Neurological Disorders
and Stroke (NINDS)
National
Institute on Deafness and Other Communication Disorders (NIDCD)
Sources
Caruso, A.J., & Strand, E.A. (1999). Clinical
management or motor speech disorders in children. New
York,
NY: Thieme Medical Publishers, Inc.
Haynes, S. (1985). Developmental apraxia of speech: Symptoms and
treatment. In D. Johns
(ed.), Clinical Management of
Neurogenic Communication Disorders (pp. 259-266). Boston:
Little, Brown & Co.
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