Many
children with verbal apraxia do NOT have limb apraxia, but it's always
important to have a knowledgeable professional diagnose your child.
"Overall
apraxia" is often referred to as "limb apraxia," referring
to the arms and legs. Like verbal apraxia, it has a number of names. It is also referred to as "motor planning" deficits, global apraxia/dyspraxia,
postural praxis, etc.
In
the 70's and 80's, Occupational Therapists were very interested in dyspraxia
and its relationship to learning disabilities. An Occupational Therapist
by the name of Jean Ayres was the primary researcher in this area and developed a very
sophisticated battery of standardized tests called the Sensory Integration
and Praxis Tests (SIPT). This battery of tests can only be administered
by an SIPT certified therapist. A child should ideally be of a mental
age of about 5 years in order to sit through and comprehend the complexity
of these tests. There are a number of sub tests that evaluate all aspects
of "motor planning" (praxis), some of which include:
- constructional
praxis: the ability to motor plan how to copy a 3-D block structure
- praxis on verbal
command: telling a child what to do ("stick out your tongue"; "cross
your arms")
- postural praxis: imitating different body/limb positions, etc.
In
order to determine whether or not your child actually has "dyspraxia," it is not necessary that they have this test performed. An experienced
OT can make clinical interpretations based on your information, developmental
history, observations and administration of a variety of motor tasks.
Not being able to stick out tongue is considered oral-motor praxis,
which can exist without global apraxia; shaking head yes/no may be
related to a deficit in "gestural praxis or symbolic communication." Technically,
children with apraxia should have intact muscle strength and skill but
simply aren't able to demonstrate these skills "on command" or "voluntarily".
That is why one might see a child with apraxia shake her head yes/no when
happy/sad but cannot do this upon request or in imitation. She might
smile spontaneously but not in imitation/command, might be able to lick
peanut bitter off her upper lip, but cannot stick out tongue on command
/ voluntarily (suggesting it is not a problem with coordination / strength
/ ability, but rather an issue with "voluntary control" out of a task
context). The child should be able to pick up a cheerio with a pincer
grasp, but cannot imitate this finger position when asked to touch her
thumb to each finger tip, nor would she be able to be successful with
an UNFAMILIAR or NOVEL motor task that has not been "practiced" or achieved
after multiple attempts, (i.e. using scissors, placing a peg in a hole
when one has not had this experience before)
For more information on global praxis/motor planning deficits, see the
following web sites:
Sensory
Integration International,
will provide you with specific information regarding therapists that have
been certified to administer the SIPT. This organization was founded
by Jean Ayres.
