Friday, July 27, 2007

Apraxia

What is apraxia? I will keep adding to this untill I get it right.

Neurological Causes
The theory outlined by Gerald Edelman in 1992 suggests that the condition is caused by the failure of the neurones in the brain to develop correctly. This failure of the neurones to form adequate connections means that the brain takes longer to process information and there is a greater likelihood of the brain losing the suggestion and the child therefore failing to respond to requests given to him.

Apraxia can be severe, and it's not limited to speech. Apraxia is a neurologically based motor planning and sequencing disability. Anything that requires a plan and a sequence for muscle response, like jumping ,hopping, riding a bike, writing with a pencil etc., is affected. It most profoundly affects speech because so many muscles are utilized at one time. There are 17 muscles in the tongue alone!
.
There are various kinds of apraxia that affect different types of movement, including:

Ideomotor apraxia. Inability to mimic or perform a movement (e.g. hammer a nail, brush hair, blow out a match, cough) in response to a verbal command.

Ideational apraxia. Inability to correctly perform a series of movements to accomplish certain tasks (e.g., writing, bathing, dressing, eating or brushing teeth). Patients also may not know how to appropriately use certain tools or objects. For instance, a pen may be used in the manner of a comb.

Verbal apraxia. Inability to coordinate lip, mouth and tongue movements in order to speak. People with verbal apraxia may be unable to say a word correctly and consistently (they can say a word correctly one moment but not the next).

Buccofacial apraxia. Inability to perform movements of the face and mouth (without typically affecting a patient’s ability to speak). Patients with verbal apraxia may not be able to lick their lips, blow, cough or wink upon verbal command.
Additional types of apraxia that some experts believe should not be considered true forms of apraxia include constructional apraxia, limb-kinetic apraxia and oculomotor apraxia.

Childhood apraxia of speech (CAS, also known as DVD -- developmental verbal dyspraxia, and DAS -- developmental apraxia of speech) is a disorder that is more easily defined by what it is not. It is not a muscle disorder. It is not a cognitive disorder (although it may have some impact on language as well as speech). The problem occurs when the brain tries to tell the muscles what to do -- somehow that message gets scrambled. It's like trying to watch cable t.v. stations without the right descrambler. There is nothing wrong with the t.v. station, and nothing wrong with your set. It's just that your set can't read the signal that the station is sending out. The child's language-learning task is to figure out how to somehow unscramble the mixed message her/his brain is sending to her/his muscles. The

CAS has much more effect on volitional (voluntary, creative) speech than on automatic speech. This means that the more your child wants to communicate a particular message, the harder it will be! So, if you happen to hear her/him say something once when there is no pressure, and you say, "Say it again!", you are guaranteeing that she/he won't be able to. It is vital to put a minimum of communication pressure on the child. (NOTE: Your child's speech- language pathologist will need to put communication pressure on the child.) Low-pressure verbal activities are the most important thing a parent can do to help. These include: songs (especially repetitive songs, like Old MacDonald and finger-plays), poems, verbal routines (pat-a-cake, Willoughby Walloby Woo, etc.), repetitive books (such as some of the Mercer-Mayer books, Little Bear, etc.) and daily routines (prayers, social greetings, salute to the flag, etc.). You can make other activities into verbal routines: make up little sayings or poems that you say every time you do the same thing, label instead of counting objects in counting books ("Three dogs: dog, dog, dog"), verbalize repetitive activities (e.g., setting the table: "Plate, plate, plate, plate; fork, fork, fork, fork.."), and so on. Don't make a big fuss about whether or not your child is talking or singing along; just provide a supportive environment for her/him to do so. Don't ever say "You can't have it unless you say it first" -- that's sheer torture for a child with CAS. If your child is unable to communicate effectively right now, the use of sign language or a communication board to supplement speech temporarily not only decreases the frustration but also even seems to help with speech development. Don't be afraid to try it! Dyspraxia may affect other motor functions (e.g., fine motor control, gross motor planning) and other language functions (e.g., learning grammatical function words like "the, "is", "or", etc.; learning more complex grammatical forms like passive; spelling; putting words together into a sentence or sentences together into a paragraph, etc.). Occupational therapy, physical therapy, and learning disabilities assistance are often helpful for children who have these difficulties. CAS can be a very frustrating disorder at times. It is common for children to make progress in "fits and starts" -- good progress for a little while, then none, then more, etc. Don't get discouraged! The therapy is helping, even if you don't see the effects immediately.

The cause or causes of DAS are not yet known. There are scientists who believe that DAS is a disorder related to a child's overall language development. Others believe it is a neurological disorder that affects the brain's ability to send the proper signals to move the muscles involved in speech. Some findings suggest that heavy metals may play a role in the disorder.

A qualitative impairment in communication (APA, 1994), and such impairment is a primary feature of mercury poisoning.
Mercury-exposed children especially show a marked difficulty with speech (Pierce et al, 1972; Snyder, 1972; Kark et al, 1971). Even children exposed prenatally to “safe” levels of methylmercury performed less well on standardized language tests than did unexposed controls (Grandjean et al, 1998). Iraqi babies exposed prenatally either failed to develop language or presented with severe language deficits in childhood. They exhibited “exaggerated reaction” to sudden noise and some had reduced hearing (Amin-Zaki, 1974 and 1979). Iraqi children who were postnatally poisoned from bread containing either methyl or ethylmercury developed articulation problems, from slow, slurred word production to the inability to generate meaningful speech. Most had impaired hearing and a few became deaf (Amin-Zaki, 1978). In acrodynia, symptoms of sufferers (vs. controls) include noise sensitivity and hearing problems (Farnsworth, 1997).

Could there be a link with the pharmaceutical companies who made vaccines with mercury? The doctors who gave the vaccines, insisted they were safe; and likewise we have the scientists who said they could not find a link between autism and mercury. If there's no ``evidence of harm, then why did government officials begin removing thimerosal from the vaccines in 1999? With families struggling to find the answers and help for their children's neurological symptoms. Like U.S. Representative Dan Burton, who believes his two grandchildren suffered from thimerosal exposure in vaccines. I was not so sure there isn't a link. But then Jaded said... "I also wanted to mention that all of the newest research indicates that mercury plays no part in autism rates either in the US or internationally. Any of the studies done that indicate it does were either anecdotal or flawed". The MMR-Autism theory came to the forefront in 1998 when British Gastroenterologist Andrew Wakefield and his colleagues reviewed reports of 12 children with bowel disease and regressive developmental disorders, mostly autism, and that seemed to arise shortly after having a vaccine. The parents of nine of these children - or their pediatricians - suggested that MMR vaccinations led to the intestinal abnormalities. The study has several limitations: there were too few cases to make generalizations about the causes of autism, the cases were referred to the researchers, rather than chosen at random, and thus may not be a representative sample of cases of autism, and finally, there were no healthy control group children for comparison. In at least four of the cases, behavioral problems had begun before the symptoms of bowel disease, meaning it is unlikely that bowel disease or the MMR vaccine caused the autism. In 2004, 10 of the 13 authors of the study retracted the paper’s interpretation, saying that the data was insufficient to establish a causal link between the MMR vaccine and autism.
And a study by scientists at the University of Rochester Medical Center is the latest in a series of updates on children who have been studied since their birth in 1989 and 1990 in the Republic of the Seychelles, an island nation in the Indian Ocean. The children have been evaluated five times since their birth, and no harmful effects from the low levels of mercury obtained by eating seafood have been detected.
CAMBRIDGE, Massachusetts, August 26, 2003 (ENS) -
Autism may be a form of mercury poisoning brought on by exposure to the mercury based preservative thimerosal in vaccines, according to new research published in the current issue of "International Journal of Toxicology," the official journal of the American College of Toxicology.

The study provides the strongest clinical evidence to date supporting the theory that mercury exposure is tied to autism, a finding that is not a surprise to coauthor by Mark Blaxill, a director of Safe Minds, (Sensible Action For Ending Mercury-Induced Neurological Disorders). This nonprofit parents' organization was founded to investigate the continuing risks to infants and children of exposure to mercury from medical products, including thimerosal in vaccines.

Methylmercury has always been found naturally in fish and in our bodies, but the trace levels of human exposure haven't increased in centuries; in fact, they're dropping. And research that has followed thousands of pregnant women and their children for nearly 15 years has found no evidence that the amounts of methylmercury in our fish put children or newborn babies at risk. Even among populations eating ten or more times the amounts of fish consumed by Americans, scientists have found no credible evidence of neurotoxicity, let alone brain damage, developmental delays, retardation, or learning disabilities.

The sky-is-falling crowd of activists and government officials remains unconvinced. They persist in warning women that there is real risk in exceeding EPA-established thresholds of methylmercury exposure that were set arbitrarily and with overly conservative safety margins. To determine acceptable levels of methylmercury, the EPA began with an amount at which there was no observed effect at all in the most sensitive of the population with a lifetime of exposure — a level nearly ten times that found in American women — and then added another tenfold safety cushion to that.
In the end, it seems that no one knows who or what to blame.




The Childhood Apraxia of Speech Association of North America (CASANA)

56 comments:

Jaded said...

Thank you.

Jadette's apraxia is severe, and it's not limited to speech. Apraxia is a neurologically based motor planning and sequencing disability. Anything that requires a plan and a sequence for muscle response, like jumping ,hopping, riding a bike, writing with a pencil etc., is affected. It most profoundly affects speech because so many muscles are utilized at one time. There are 17 muscles in the tongue alone!

Jadette is not cognitively impaired. She understands everything that is said to her. She is almost trapped inside her head, because she can't form much speech no matter how hard she tries. She does use ASL, but again, that requires a spontaneous muscle response in a specific order. I'm very proud of her, because she works very hard. Even though she's often difficult to understand, she keeps trying.

Jaded said...

I also wanted to mention that all of the newest research indicates that mercury plays no part in autism rates either in the US or internationally. Any of the studies done that indicate it does were either anecdotal or flawed. Regardless, Jadette was not exposed to it because it had been removed from vaccines prior to her receiving any. I hate seafood, so I didn't accidentally expose her to higher mercury levels that are sometimes found in seafood while I was pregnant.

She sees a neurodevelopmental pediatrician in north Jersey, just outside of NYC. The nation's formeost authority on apraxia, Dr. Marilyn Agin, wasn't able to treat Jadette because of her busy schedule. The doctor who does treat her is Dr. Agin's associate, and is also an expert on language/communication disorders, most specifically apraxia. It's a 2+ hour trip, but even Children's Hospital of Philadelphia, which is rated the best in the nation, didn't have an expert in apraxia on staff. (CHOP is only about an hour and 15 minutes from here)They prefer the term "Childhood Apraxia of Speech" because the term apraxia was originally used for those who lost their ability to speech, like someone who had a stroke. Most often, using the term "developmental" indicates that either a child developed it, or that it's a delay he or she will outgrow. It's not a delay, she was born with it - there are signs from birth such as low muscle tone, lack of trunk strength and texture aversions leading to eating issues - and it's a life-long communication disorder. It is a disability she will carry with her throughout her life, and there's no indication whether she'll be able to communicate "normally" or not.

I am rather like the rain man of apraxia information. I have done extensive research. The attorney who represtented us in our litigation against the school is not only a lawyer, but a Master's level speech/language pathologist. As far as Jadette's education goes, she will probably have learning disabilities where language related curriculum is concerned. I am not terribly worried about it, because I happen to have a Master's degree in Special Education. How to teach a child to learn is part of what I do. (I'm a smart girl :) )

Here are some other sites you might want to look at if you are interested and have time:

www.cherab.org
www.apraxia-kids.org
www.asha.org

Dr. Agin and Jadette's doctor, Dr. Laveman, are co-medical directors of the cherab foundation site. Dr. Agin's book, which has been considered ground-breaking in the area of apraxia, is called "The Late Talker."

I'll stop now...I can go on for hours about this stuff, lol.

Walt said...

Once again I see that neurological nutrition keeps comming up in my blog searches. They also tend to link Autism, Attention Deficits (ADD),ADHD, Dyslexia and Dyspraxia all together. I will try some of this and see if it helps my brother.

Current Successful Gut-related Interventions
1. Gluten/Casein-free diets: Key peptidase is produced by the intestinal membrane.
2. Anti-viral agents and IV gamma globulin: May affect chronic intestinal infection.
3. Digestive Enzymes: Multiple choices, including special peptidase and prescription microencapsulated forms.
4. Floral Remediation: antifungal, antibacterial and regular probiotic are mainstay treatment.
5. Secretin: Produced by the small intestine, stimulates digestive enzymes, trophic and stimulates blood flow to the intestine, triggers digestive juices from the pancreas, increases immune levels in bile.
6. Cod liver oil: vitamin A supports gastrointestinal membranes and mucin production. EPA in cod liver oil is anti-inflammatory.
7. Bethanecol: Stimulates all-important acid production by the stomach, tightens gastroesophageal sphincter to stop reflux espohagitis, stimulates digestive enzymes, trophy to pancreas, stomach, small and large bowel mucosa, stimulates definsins release by paneth cells for local immunity, promotes ordered peristalsis.
8. DMSA and Lipoic Acid: Remove heavy metals, which have particularly high affinity for intestine. Mercuric cation at nanomolar concentrations completely inhibits activation of B6 in the intestinal mucosa. Floral alterations may affect heavy metal recirculation and heavy metal levels in the lumen may affect floral composition.
9. Zinc: Last line of defense in protection of cell membrane sulfhydryls from oxidation; inhibits bacterial lipase; lessens intestinal permeability; increases intestinal PGE1 for immune function. Necessary for stomach acid production and vitamin A metabolism.

Strategy: Assure Generous Levels of the Key Nutrients
1. Vitamin B6: Pyridoxal-5-phosphate is activated form.
2. Magnesium: glycinate form most absorbable.
3. Zinc: Picolinate form most absorbable. Dose away from minerals and food which block absorption. Balance with manganese. Warts, stretch marks, flecks subside.
4. Calcium: Assure RDA of about one gram daily plus some require extra.
5. Selenium: Doses up to 200 mcg daily as anti-oxidant and to bind mercury.
6. Vitamin A: Cod liver oil for all behavioral children unless allergic to cod.
7. Vitamin C: Twice-daily dosing rationale; also helps regularize bowel movement.
8. Vitamin E: Important chain-breaking anti-oxidant.
9. Fish Oil: Quiet inflammation with EPA. High EPA/DHA preparations available.
10. Evening Primrose Oil: Good for the gut, growth and immunity.
Particularly Important for Immunity: Zn, Vitamin A, GLA

Management of Nutrition and Gut
History and physical: Dry skin, hair, allergies, thirst, frequent infections and dyspraxia suggest fatty acids; nail flecks and lighter hair for low zinc; indirect gaze for vitamin A; rashes and carbohydrate cravings for fungal overgrowths: abnormal stool consistency and frequency; response to food challenges

Laboratory: Select sensitive lab measurement for nutritional assessment, such as RBC (intracellular) mineral levels, RBC-membrane fatty acids, functional vitamin assay; for key nutrients, treat low-normal lab ranges and do follow-up studies to verify correction. Newer testing modalities such as IgG food allergy blood testing and urinary organic acids are useful.

1. Routine chemistry profile, thyroid, complete blood count and urinalysis
2. Stool studies: culture and sensitivity, parasitology, steatocrit
3. Urinary organic acids
4. Urinary pyrroles: Elevation in twenty-five percent implies primary Zn and B6 need. Off Zn and B6 prior to collection
5. Urinary peptides: Or, empiric trial gluten/casein-free
6. IgG blood test for food allergies
7. RBC mineral levels
8. Sensitive vitamin assay
9. RBC membrane fatty acids
10. Amino acid levels: methionine, taurine, and glutamine very important
11. Heavy metals levels and MELISA for allergic reactivity to metals

Treatment Guidelines
1. Principle: If rationale exists for an intervention, continue it unless there is a reason to stop or change it. Nutrients, floral remediation, digestive enzymes and detoxification take time to work and they work together.

2. Combination formulations can be beneficial.

3. Tailored nutritional programs: Include B6 (P5P) and magnesium, zinc, calcium, vitamin C, vitamin E, selenium, cod liver oil and fatty acids. Add one nutrient at a time, sometimes trying lower doses. In the allergy-prone child, start with fish-oil, then balance with evening primrose oil.

4. Assure anti-oxidant coverage before administering oils: Zinc and biotin co-factors for conversion of GLA from EPO.

5. Effective levels of anti-oxidant nutrients

6. Reduce over-all oxidative stress, which is additive.: Avoid exposure to classical allergens such as pets and pollens as associated with hay fever and asthma.

7. Floral remediation: anti-parasitics, nystatin and other anti-fungals and regular probiotics are key. Lactobaccillus GG especially effective for clostridia. Some stool overgrowths may require specific antibiotics; antibiotics generally should be avoided to promote healthy flora.

8. Address food intolerance: Avoid aggravating foods to halt IgG (and IgE) reactivity to food antigens which keeps the bowel inflamed. Gastrocrom, quercitin, EPA (fish oil), vitamins C and E all quiet inflammation.

9. Digestive enzymes with all meals and snacks.

10. Avoid NSAIDS (non-steroidal anti-inflammatory medication) to lessen leaky gut.

11. Glutamine as nutrient for the enterocyte.

12. Decrease toxic burden: Organic food free of insecticides, antibiotics, flavor enhancers, artificial sweeteners, colors, and preservatives. Purified water, clean home and school environments. Assure bowel regularity (fiber, magnesium citrate, vitamin C, Bethanecol) to reduce toxins. The autistic child should eat regularly, several meals per day.

13.Detoxification with DMSA/lipoic acid: precede by nutritional and gut enhancement. Floral influence on metals retention may be significant. Fluctuations in dysbiosis may be related to changes in heavy metals levels.

Jaded said...

Yeah, they often lump apraxia in with other things, like autism, even though they're two completely different things. Autistic children also tend to be apraxic, however, not all apraxic children are autistic. Much of the current reseach shows that certain types of fatty acids do help with neurological processes, like, omega 3 and omega 6. They seem to work best when they contain borage oil as opposed to primrose oil. The most studied one is a brand called ProEFA by Nordic Naturals.(www.nordicnaturals.com)

It comes in both capsule and liquid form. I have a hard time getting Jadette to take it, because even though it has a strong lemon flavor, it still smells like fish. She's not much interested in the lemony fish gunk. The capsules are too large for her to take, so I have to puncture them and ad the oil to her food, so it's just easier to try the bottle of liquid. Unfortunately, the lemony fish taste doesn't help make her foot tast good, so she refuses to eat it! Ugh!

Walt said...

Oil that girl up! And say a blessing over everything that you give to her. I may have lost my religion, but I know there is a God. Indeed, I have seen great miracles happen, and I expect no less for Jadette.

Look Who’s Talking Now: Fish oil capsules help children with speech disorders find their voices EngleMed

That’s the conclusion of a group of scientists who reviewed a study of nineteen youngsters suffering from various speech problems. The children, ranging in age from two years to eight years, were given a fish oil supplement containing a mixture of omega-3 and omega-6 essential fatty acids (EFAs). Speech-language pathologists who monitored the children reported significant improvements within just a few weeks. The improvements were noted not only in the children’s ability to talk, but also in their behavior, ability to focus, and in maintaining eye contact.

Now the scientists, brought together by the CHERAB Foundation, a major nonprofit group for children with speech disorders, are calling for a large-scale clinical trial to validate these initial findings.

“The results were dramatic,” says developmental pediatrician Marilyn C. Agin, M.D., medical director of the New Jersey-based foundation, who also reported similar results in ten anecdotal cases. “They strongly suggest that EFA supplementation combined with speech and occupational therapy could become the treatment of choice in multifaceted communication disorders.”

Until now children with severe speech disorders such as apraxia, a neurologically-based condition, have required years of intensive one-on-one therapy—often with painfully slow progress. “But now, with EFA supplementation, the future for these children may be much brighter—and sooner rather than later,” says Lori L. Roth, M.S., CCC/SLP, a speech pathologist with the CHERAB foundation.

The amazing potential of EFA supplementation came to light when the nonprofit group’s president, Lisa Geng, used it with her three-year-old son, Tanner. After just three weeks his vocabulary exploded. “It was the breakthrough we had been praying for. It was incredible,” says Lisa.

Why does this supplementation work? The experts believe that the speech disorders are the result of a breakdown in communication between the brain and the muscles in the mouth, tongue and jaw that have to work together to produce speech. Essential fatty acids, especially the omega-3 DHA and the omega-6 fatty ARA, are highly necessary for brain development. Most children obtain them—during the most critical times of brain development—directly from their mothers while they are still in the womb and subsequently while being breast-fed. Any deficiency can result in permanent neurodevelopmental deficits in the growing infant.

“Therefore, essential fatty acid supplementation in neurodevelopmental speech disorders could correct a specific deficit in the speech center of the central nervous system,” says Robert Katz, Ph.D., CHERAB’s director of EFA research.

The panel of experts who reviewed the study included scientists from the NIH, Johns Hopkins University, Kennedy Krieger Institute, University of Kansas, and Oxford University, England. They join a growing group of researchers who are heralding the benefits of essential fatty acid supplementation for a wide range of brain-related problems including depression, bipolar disorder, schizophrenia, attention deficit hyperactivity disorder, dyslexia, and even Alzheimer’s disease and autism.
For more information contact:

______________________________________________________

CHERAB FOUNDATION

COMMUNICATION HELP, EDUCATION, RESEARCH, APRAXIA BASE

help@cherab.org

Web site http://www.cherab.org

Bridges for Kids.

akakarma said...

Where I work the psychiatrist prescribes Cod Liver Oil for BiPolar Disorder. My daughter has Down Syndrome and she has some speech delays. This has forced me to learn so much about language and the brain- a great frontier. I didn't know you had a Master's in SPec Ed Jaded? Keeper- do you have a special interest in this area too? Come see my daughter on my blog!

Anonymous said...

Hello! I would like to speak to Jada about my 6 yr old daughter who has GDD, Apraxia, Hypotonia, and SID. Her web site would not allow anonymous comments. I would like to ask about Dr. Agin as well. Thanks! Gingercek1@aol.com

Anonymous said...

Ah, This is spot on! Puts to bed
some misnomers I've read

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