La.apraxia

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