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Scientific Programs

ProEFA, EFA, DHA...What's that?!

 

What is ProEFA, EFA, LCP, and DHA?  And what about GLA, and EPA?  And could they possibly help your child?  The answer will be clear to all in the near future.  This is because CHERAB will soon begin research on apraxia and EFAs (Essential Fatty Acids) based on the outcome of the hugely successful First Scientific Conference Dedicated to the Therapy of Verbal Apraxia/Dyspraxia.   The scientific findings of The First Apraxia Conference were also presented at Oxford and are written up in our Press Release.  But starting with the basics, EFA, what's that?... 

Elementary Introduction to Essential Fatty Acids (EFAs)

Slides Presented in Part at The First Conference on Therapy for Verbal Apraxia/Dyspraxia "Essential Fatty Acids (EFA) in Verbal Apraxia: A New Potential Therapeutic Intervention"

July 23-24, 2001 Headquarters Plaza Hotel, Morristown, New Jersey, U.S.A.

Robert Katz, Ph.D.

Managing Director, Consortium for Brain Fatty Acids, Omega-3 Research Institute, Inc., and

Director of EFA Research, CHERAB Foundation, 

bulletElementary Introduction to Essential Fatty Acids (EFAs)
bulletThe Omega-6 and Omega-3 EFA Families of PUFA (1)
bulletThe Omega-6 and Omega-3 EFA Families of PUFA (2)
bulletThe Omega-6 and Omega-3 EFA Families of PUFA (3)
bulletEFAs and Eicosanoids
bulletEFAs in Inflammation
bulletRecommended Adequate Intake of EFAs
bulletOmega-3 PUFA and Their Systemic Presence
bulletRelevant Books on Omega-3 PUFA

Elementary Introduction to Essential Fatty Acids (EFAs)

  The structure of fatty acids is like a long chain with many links and a Carbon atom at each joint between two  links and at both ends of the chain.  One of the ends of the chain contains the acid moiety, the other has only the carbon atom and hydrogen atoms.  A carbon-carbon link can be single (like in saturated fats which are solid at room temperature and are components of red meats) or it can be double or unsaturated.  If the fatty acid has one double bond it is called monounsaturated like oleic acid, the main component of olive oil.  If it contain two or more double bonds it is called polyunsaturated fatty acid (PUFA) like the omega-6 and omega-3 families. TOP

The Omega-6 and Omega-3 EFA Families of PUFA (1)

There are two main families of polyunsaturated fatty acids (PUFA): 
The Omega-6 Family and The Omega-3 Family
Linoleic (LA)                   Alpha-linolenic (LNA or ALA)
(C18:2 n-6; #C atoms,        (C18:3 n-3)
2 Double Bonds)
Gamma-linolenic              Stearidonic (SDA)
(GLA), (C18:3 n-6)           (C18:4n-3)
Dihomogamma-linoleic      Eicosapentaenoic (EPA)
(DGLA), (C20:3 n-6)        (C20:5 n-3)
Arachidonic (ARA)          Docodapentaenoic (DPA)
(C20:4n-6)                         (C22:5 n-3)
Docosatetraenoic acid      Docosahexaenoic (DHA)
(DTA) (C22:4 n-6)          (C22:6 n-3) TOP

The Omega-6 and Omega-3 EFA Families of PUFA (2)

Members of each family are either essential i.e., our body cannot make them (such as LA and ALA) or conditionally essential that is, if we ingest enough LA and ALA in our food (see below for recommended daily intake) our bodies can manufacture all the others.  This biochemical-physiological process is however slow and inefficient, especially in the fetus, premature newborn and developing infant. Thus Ara, EPA and DHA are provided by the mother directly through the umbilical cord or breast milk. Very  recently  the FDA approved supplementation of infant formulas with DHA to satisfy the infant’s needs for appropriate brain and retina development and with Ara to ensure appropriate general development and growth. Direct DHA supplementation is more needed than EPA supplementation.  The reasons are not clearly understood yet.  It is known however that EPA does not accumulate and persist in the brain like DHA.  It is transformed into DHA and hormone-like materials. TOP

The Omega-6 and Omega-3 EFA Families of PUFA (3)

 Omega-6 Oils
LA is abundant in corn oil, safflower oil, sunflower seed oil, cottonseed oil, soybean oil, peanut oil, sesame oil or grape seed oil.  GLA is abundant in borage oil and evening primrose oil. Ara is abundant in  red meat
Omega-3 Oils
ALA is abundant in flaxseed oil, canola oil, walnut oil and to some extent in soybean oil.  EPA and DHA are in fish, other seafood, fish oils and algal oils,

Thus, in the human body: LA goes to GLA>Ara and ALA->EPA->DHA
(Both Ara and EPA are starting materials for cellular, hormone-like molecules called eicosanoids or prostaglandins) TOP

EFAs and Eicosanoids

Omega-6 prostaglandins (PGs) are potent stimulators of muscle contraction and platelet aggregation, e.g., thromboxane.
Omega-3 PGs are vasodilators that regulate blood pressure and inhibit platelet aggregation
--------------------------------------------------
Omega-6 PGs can induce labor by causing contractions of the womb
Omega-3 PGs can relax the myometrium TOP

EFAs in Inflammation

The omega-6 prostaglandin PGE-2 is involved in fever, pain and swelling, menstrual cramps, inflammatory bowel disease, the omega-3 PGE-3 has low inflammatory potential.
The omega-6 leukotriene  LTB-4 is involved in asthma, emphysema, bronchitis, dermatitis, psoriasis and ulcerative colitis, while the omega-3 LTB-5 also has low inflammatory potential.
Schematically
PGE-2                                                        PGE-3
            Cyclo-oxygenase enzyme (COX)
    Ara                                                           EPA
             Lipo-oxygenase enzyme (LOX)
LTB-4                                                        LTB-5 TOP

Recommended Adequate Intake of EFAs

Fatty Acids      Grams/Day     %Energy
     LA                    4.44                2.0
  upper limit           6.67                3.0
____LNA              2.22                 1.0
 DHA & EPA           0.65                 0.3
DHA at least*        0.22                 0.1
Trans Fatty Acids<2.00___________
* For pregnant and lactating women 0.3 grams/day of DHA
A ratio of omega-6:omega-3 of 2:1 up to 4:1 is recommended
According to the USDA the average ratio of omega-6:omega-3 consumed by the US population is about 10-1. TOP

Omega-3 PUFA and Their Systemic Presence

Roles in cardiovascular disease: maintain lower levels of serum triglycerides, maintain healthy platelet function and blood coagulation levels, lower the risk of sudden death from stroke or cardiac infarct
Roles in prevention and therapy of cancer: are regulators of cancer cell death (apoptosis) during carcinogenesis (breast, prostate and colon cancers),  reduce anticancer drug toxicity and facilitate the therapeutic effect of some anticancer drugs
Roles in the eye and brain: are potential regulators of retinal and neuronal signal transduction, appear to be regulators in mood disorders. 
What is their role in verbal apraxia? TOP

Relevant Books on Omega-3 PUFA

To learn about the importance of EFAs and their roles in the Central Nervous System see the following books:
1. B. Jacqueline Stordy, Ph.D., and Malcolm J. Nicholl, “The LCP Solution”,  Ballantine Books, New York, NY, 2000 (available from the CHERAB Foundation)
2. Andrew L.Stoll, M.D., “The Omega-3 Connection,” Simon and Schuster, New York, NY, 2001
To learn about EFAs in general, and how to integrate them in a healthy everyday diet, please consult the following book:
3.  Artemis P. Simopoulos, M.D., and Jo Robinson, “The Omega Plan,” HarperCollins Publishers, New York, NY, 1998 TOP 

CHERAB Foundation Scientific Programs

The following was from 'the First Apraxia Conference' July 23-24, 2001,Headquarters Plaza Hotel, Morristown, New Jersey USA

and was also presented at the Research Workshop - September 20-21 and on September 22, 2001  'Fatty Acids in Neurodevelopmental Disorders' St Anne’s College, Oxford, UK

CHERAB FOUNDATION SCIENTIFIC PROGRAMS

VERBAL APRAXIA/DYSPRAXIA and the THERAPEUTIC ROLE of
ESSENTIAL FATTY ACIDS:

The Perspectives of Speech Pathologists:

The Perspective of a Developmental Pediatrician:

A Time Line of Therapeutic Outcomes in
Speech/Communication

Conclusions:

CHERAB FOUNDATION PROFESSIONAL STAFF

Organizers and Scientific Panel Members of the First
Conference on Verbal Apraxia/Dyspraxia

 

CHERAB FOUNDATION SCIENTIFIC PROGRAMS

The first conference for therapy of verbal
apraxia/dyspraxia entitled: "Verbal Apraxia/Dyspraxia
and Essential Fatty Acid (EFA) Supplementation: A New
Potential Therapeutic Intervention," 23-24 July, 2001,
Headquarters Plaza Hotel, Morristown, New Jersey,
U.S.A., was organized under the auspices of the CHERAB
Foundation and the Consortium for Fatty Acids, Omega-3
Research Institute, Inc. The research findings
described below were presented by CHERAB Foundation
professional staff to a panel of participating experts
for their review. The panel recommended the initiation
of clinical trials to validate the potential
therapeutic effects of EFA supplementation in verbal
apraxia and autism. The data was also presented as
three posters at the Conference on "Fatty Acids in
Neurodevelopmental Disorders", September 20-21, 2001
Oxford, United Kingdom.

VERBAL APRAXIA/DYSPRAXIA and the THERAPEUTIC ROLE of
ESSENTIAL FATTY ACIDS:


Marilyn C. Agin, M.D., New York City Early
Intervention, New York, and CHERAB Foundation,
Gillette, New Jersey

Robert Katz, Ph.D., Consortium for Fatty Acids,
Omega-3 Research Institute, Inc., Bethesda, Maryland
and CHERAB Foundation, Gillette, New Jersey

Lori L. Roth, CCC SLP, CHERAB Foundation, Gillette,
New Jersey

Verbal Apraxia (VA) affects the programming of the
articulators and rapid sequences of muscle movements
for speech sounds. These children frequently display
neurologic “soft signs” including hypotonia, sensory
integration disorder, and motor planning difficulties.
The speech assessment reveals a limited repertoire of
consonant sounds, inconsistency of speech errors, and
sound/syllable omissions. These children usually have
near-normal receptive language and intelligence. It is
a difficult speech disorder to treat with variable
outcomes. Many children never develop intelligible,
conversational speech. Dramatic leaps in speech
progress have been noted with essential fatty acid
(EFA) supplementation by parents and professionals.
The most often used EFA supplement is a 1000 mg
capsule containing a mixture of DHA (docosahexaenoic
acid, 99 mg.), EPA (eicosapentaenoic acid, 148 mg.),
GLA (gamma-linolenic acid, 40 mg) available under the
name of ProEFA or Complete Omega and manufactured by
Nordic Naturals, California.


The Perspectives of Speech Pathologists:

Our objective was to assess potential therapeutic
effects of essential fatty acid (EFA) supplementation
of children with VA by surveying speech pathologists
that provide speech therapy to the supplemented
children. A total of nineteen speech pathologists
(eighteen of them independent), returned the
questionnaires that constituted the professional
anecdotal case reports included in this analysis. The
patient population consisted of 16 males (including
one pair of identical twins) and 3 females, mostly
between 27-97 months of age. Seventeen of the 19
patients were supplemented with ProEFA (13 with one
1000 mg softgel capsule/day and four with two).
Outcome  variables measured included the following:
speech,
affect, muscle tone, muscle control, behavior, social
skills, attention, eye contact, and academic ability.
Post-supplementation, the children were rated
according to the following
scale: 1=not sure, 2=no change, 3=subtle change,
4=moderate 5=significant, 6=outstanding change. 

The analysis of data led to the following conclusions:
a) EFA supplementation resulted in a marked shift in
verbal statement ability from the nonverbal end toward
the singing end of a hierarchical sequence, i.e., from
decreases in nonverbal, gesturing, grunting, single
sounds, to increases in single words, multiple words,
sentences and singing. b) Seventeen of the 19 subjects
(89%,) showed varied degrees of improvements in the
Speech outcome variable. Of these improvements 9 (53%)
were subtle, 5 (29%) were moderate and 3 (18%) were
significant. Only two patients (11% of 19) showed no
improvement.

The nineteen reports were divided in two subgroups
according to the effect of supplementation on the
speech/communication outcome variable. A statistical
test indicated that improvements in speech of patients
in Subgroup 2 (containing all eight cases representing
moderate and better than moderate improvements scores
of 4 and 5 respectively), are significantly higher
than the improvements in speech of patients in
Subgroup 1 (containing the eleven cases representing
the no-change and subtle improvement scores of 2 and 3
respectively). Three patients in Subgroup 2 were
diagnosed with verbal apraxia (one mild, one moderate
and one severe case). In addition, the mild case also
had feeding-swallowing disorder. A fourth patient was
diagnosed with mild VA and oro-motor hypotonia,
additional three patients had severe VA with hypotonia
and sensory integration disorder (SID). One of these
also had autism and another was suspected to have
ADHD. The eighths patient had mild VA with hypotonia
and SID. The patient with autism showed moderate
improvement in speech and better than moderate
improvements in behavior and attention. Descriptive
statistics (mean and standard deviation) of all
variables surveyed in the population of Subgroup 2
indicate (in order of decreasing means) that
improvements in Speech (4.4(0.5) > Attention (4.0(1.5)
= Behavior (4.0(1.9) > Affect (3.4(0.6) = Social
Skills (3.4 (1.4) = Eye Contact (3.4(1.7) > Muscle
Tone (3.1(1.6) > Muscle Control/Coordination
(2.7(1.0).

The Perspective of a Developmental Pediatrician:

Anecdotal case reports provided by the CHERAB
Foundation's Developmental Pediatrician were also
analyzed. Ten children were supplemented: Nine had the
diagnosis of VA; one had a dual diagnosis of VA and
pervasive developmental disorder (PDD-NOS), and one
was autistic with an expressive language disorder.
Eight of the children were receiving 1 capsule/day of
ProEFA and 2 were receiving 2 capsules/day. The
majority of the children had been supplemented for at
least three months. All of the children were receiving
speech therapy at least three times a week. Age range
was 32 months to 96 months old. Descriptive statistics
were used to analyze the data. The same outcome
variables and scoring scales have been used as above.
The variables that showed the most improvement were
speech and attention,
with means of 4.7 (SD=1.3) and 4.1 (SD=1.2)
respectively. According to the scale, this correlated
with moderate to significant improvement. To a lesser
degree, there was
improvement in affect and eye contact with means of
3.8 for both. There were no significant changes in the
other variables. The two children on the autistic
spectrum showed significant improvements in speech and
eye contact, with means of 5.0 and 5.5 respectively. 

A Time Line of Therapeutic Outcomes in
Speech/Communication


Speech therapy intervention has been an integral part
of a program designed to treat children diagnosed with
VA. Speech therapy approaches from oral motor
patterning to “traditional” articulation drills yield
fair success over lengthy periods of time. The
potential therapeutic effect of EFA supplementation
initiated by parents was followed in four children
with VA by the CHERAB Foundation's speech pathologist.
Outcomes of the study are reported here. An initial
evaluation consisting of a receptive and expressive
language test, oral motor coordination examination and
verbal/sound production test (Receptive One Word
Vocabulary Test, Expressive One Word Vocabulary Test,
Preschool Oral Motor Functioning Scale, Kaufman Speech
Praxis Test) was performed on each subject prior to
EFA supplementation. In general, the children
demonstrated age-appropriate receptive language
skills, extreme difficulty coordinating articulator
movements for sound production, and a significant
delay in expressive language skills. The children were
given a daily dose of one 1000mg capsule of ProEFA.
Two weeks into supplementation, each child began
demonstrating improved attention to task, sustained
eye contact with the therapist and calmer general
participatory behavior. Beyond this time, each child
demonstrated an improvement in the level of verbal
statement specific to the baseline performance
obtained in testing. One of the children began
supplementation essentially non-verbal and progressed
to two-word utterance production within 2 months.
Outcome measures included standardized scores from
general tests of language and measures taken from
language-sample analyses as well as an objective scale
grading speech production from non-verbal to singing.
There were modest to significant changes in
standardized measures of language after 2-3 months of
EFA supplementation in all four cases using an 80%
criterion confidence interval. These were
substantiated by the clinically significant changes in
language sample measures. Such improvement
characteristically occurs after 9 to 12 months of
intensive speech therapy intervention. 

Conclusions:

The above preliminary data provide evidence that:

EFA supplementation has great potential in
accelerating speech gains in children with verbal
apraxia/dyspraxia. Thus, EFA supplementation in
conjunction with speech therapy improved pre-speech
behaviors (eye-contact, attention to task), speech and
language production (single sound, word and sentence
production), imitation skill accuracy and decreased
inconsistent imitation errors, distractibility and
groping behaviors.

Improvements are greater than would be expected from
speech therapy alone

Verbal apraxia appears to be present in a percentage
of children on the autistic spectrum and an
association could be possible between VA and other
disorders/syndromes, such as: hypotonia, sensory
integration disorder, dysarthria, attention deficit
hyperactivity disorder, Kabuki Syndrome and cerebral
palsy. Further exploration of the basic and clinical
aspects of these phenomena appears warranted.

A panel of scientific experts at the July 23-24
Conference discussed the evidence presented above and
unanimously agreed that the existing scientific
evidence justifies planning and implementing a
comprehensive clinical trial to convincingly validate
this new, potential therapeutic intervention. The
panel discussed various clinical research alternatives
and recommended that a randomized, placebo-controlled
multi-center clinical trial of EFA and placebo
supplementation to be undertaken as soon as possible.
For example, all diagnosed verbal apraxic children,
including those with hypotonia and sensory integration
disorder, who have not been supplemented with EFAs,
would be eligible for randomization. The panel
suggested that all randomized children would be
supplemented with EFA or placebo in addition to
appropriate speech therapy. This took into
consideration the potential cooperative or possibly
synergistic effect of the combined therapies in the
treatment group. The length of the trial is proposed
to be 3 months. Improvement in verbal communication
skills, or the lack thereof, using an assessment
protocol as described above, would be the major
therapeutic outcome measured, and plasma, as well as
erythrocyte membrane EFA levels would be monitored
periodically. The two groups would consist of about
20-30 age-matched subjects. ProEFA would be the
therapeutic supplement used in the trial based on
preliminary successes attained.

CHERAB FOUNDATION PROFESSIONAL STAFF

Marilyn C. Agin, M.D., Medical Director, CHERAB
Foundation, graduated from New Jersey Medical School
in 1986, followed by a combined residency in
Pediatrics and Physical Medicine and Rehabilitation at
New York University Medical Center. She is board
certified in both fields. Prior to medical school, Dr.
Agin received her master’s degree in Communication
Disorders and was a practicing speech pathologist.
Currently, Dr. Agin is the Medical Director of the New
York City Early Intervention Program and does private
neurodevelopmental evaluations primarily for children
with communication disorders, learning disabilities,
and autism,. She is a member of the New York City
chapter of the Committee on Children with Disabilities
of the American Academy of Pediatrics (AAP), and has
been appointed to the Executive Council of the New
York City chapter of the AAP.


Robert Katz, Ph.D., Director for EFA Research, CHERAB
Foundation, received his degree in Organic/Medicinal
Chemistry from the Hebrew University, Jerusalem in
1972. During his postdoctoral fellowship (1972-1973)
at the National Institutes of Health
(NIH), Bethesda, Maryland he worked in
computer-assisted drug design of analgesics and
molecular pharmacology of neurotransmitters. From 1978
to 1993, Dr. Katz was Director of Metabolic Diseases
Research Program,
National Institute of Diabetes, and Digestive and
Kidney Diseases, NIH where he administered and managed
nation-wide research programs in membrane structure
and function, membrane protein crystallization,
structural biology (proteomics), enzyme replacement
and gene therapy, etc,. He organized workshops and
conferences in these areas and identified research
directions in need of development. Since leaving the
NIH, (1993), Dr. Katz has developed DHA- and
EPA-derivatized polycationic-lipophilic drug carriers
to the CNS. In 1998 he founded the Omega-3 Research
Institute, Inc. (O3RI), where he co-organized
international workshops on omega-3 fatty acids in
brain function, in diabetes and its cardiovascular
complications, in molecular and cellular aspects of
cancer and recently in verbal apraxia/dyspraxia.
During the last year Dr. Katz founded the Consortium
for Brain Fatty Acids, O3RI, a "center without walls"
that is providing a broad range of expert research
support to parties that require such. Dr. Katz
is co-developing the CHERAB Foundation's EFA-based
programs.

Lori L. Roth, MA, CCC-SLP, is a CHERAB Foundation
Speech-Language Pathologist and Oral Motor Specialist
with over 25 years of experience. She received her BA
degree in Psychology from G. Washington University in
Washington, D.C. in 1972. In 1974 she was awarded her
Masters of Speech and Audiology from the Catholic
University of America in Washington, DC. Ms. Roth’s
experience includes home- and hospital-based
rehabilitation, private and public school intervention
and private practice. Lori Roth was instrumental in
establishing an Infant Stimulation Program (called
Early Intervention) in Annapolis, Maryland. She has
mentored and trained graduate students in Speech and
Language Pathology from New York University, Columbia
University, Montclair State University and The College
of New Jersey as well as practicing therapists in the
State of New Jersey. Ms. Roth has presented
professional workshops for colleagues and regularly
acts as a consultant for private and public schools.

Organizers and Scientific Panel Members of the First
Conference on Verbal Apraxia/Dyspraxia


"Verbal Apraxia/Dyspraxia and Essential Fatty Acid
(EFA) Supplementation: A New Potential Therapeutic
Intervention," 23-24 July, 2001, Headquarters Plaza
Hotel, Morristown, New Jersey, U.S.A.,

Organizers:

Marilyn C. Agin, M.D., Medical Director, Early
Intervention, New York City, New York, and Medical
Director, CHERAB Foundation, Gillette, New Jersey.
(Also a scientific panel member)

Robert Katz, Ph.D., Managing Director, Consortium for
Brain Fatty Acids (CFBFA), Omega-3 Research Institute,
Inc., Bethesda, Maryland and EFA Director of Research,
CHERAB Foundation, Gillette, New Jersey (Also a
scientific panel member).



Scientific Panel Members:

Susan E. Carlson, Ph.D., Professor, University of
Kansas, Kansas City, Kansas, Member Consortium for
Brain Fatty Acids (CFBFA)


Joseph Hibbeln, M.D., Chief, Outpatient Clinic
National Institute of Alcoholism and Alcohol Abuse,
NIH, Bethesda, Maryland, Non-affilited Collaborator,
CFBFA


Nancy Kaufman, M.A., CCC/SLP, Director, Kaufman
Children's Center for Speech Language and Sensory
Disorders,
West Bloomfield, Michigan 


Ann Moser,B.S., Manager, Peroxisomal Diseases and
Fatty Acid Profiles Clinical Laboratory,Kennedy
Krieger Institute, Baltimore, Maryland. (Also a
component laboratory of the CFBFA)


Jennifer Hill-Karrer, Ph.D., Associate Professor,
University of Kansas Medical Centre, Kansas City,
Kansas, and Collaborator CFBFA


Lori Roth M.A., CCC/SLP, Speech Pathologist, CHERAB
Foundation


Andrew Zimmerman, M.D., Professor, Johns Hopkins
University and Kennedy Krieger Institute, Baltimore,
Maryland, and Collaborator, CFBFA.


Guest Panelist:

Alexandra J. Richardson, MA, D.Phil., Senior Research
Fellow in Neuroscience, Imperial College School of
Medicine, MRI Unit, Hammersmith Hospital, London; and
University Lab. of Physiology, Oxford.


The Administrative Organizers:
CHERAB Foundation


Lisa Geng, President, Suzanne Smolyar, Executive Vice
President, and Glenn W. Geng Executive Director,
Treasurer

_______________________________________________________________________


CHERAB FOUNDATION

COMMUNICATION, HELP, EDUCATION, RESEARCH, APRAXIA BASE

657 Valley Road Box 339

Gillette, NJ 07933, U.S.A.

Tel.: 732-871-6013;
Web site http://www.apraxia.cc

 

Official Post Statement from The Scientific Conference

How did this Apraxia /EFA Scientific Conference Come About?

Scientific Organizers

Scientific Panelists

Administrative Organizers

Conference Information/Agenda

EFA Resources

Apraxia...What's that?  (and how do EFAs tie in?)  From a developmental pediatrician's point of view.  By Marilyn Agin MD

EFA...What's that? (and how does apraxia tie in?)  From a scientist's point of view.  by Robert Katz PhD 

Official Statement from The First Scientific Conference Dedicated to the Therapy of Verbal Apraxia/Dyspraxia!  You may want to explore the archives of our grouplist.
 

The First Scientific Conference on Therapy for Verbal Apraxia/Dyspraxia

Post conference Statement
 
The First Scientific Conference on Therapy for Verbal Apraxia/Dyspraxia, held on July 23-24, 2001 at the Headquarters Plaza Hotel, Morristown, New Jersey under the auspices of the CHERAB Foundation (http://www.apraxia.cc), focused on "Essential Fatty Acids (EFAs) and Verbal Apraxia:  A New Potential Therapeutic Intervention."  A panel of scientific experts discussed  the evidence presented  at the conference in the form of professional anecdotal case reports on improvement of verbal communication ability with EFA supplementation in this population.  The panel unanimously agreed that the existing scientific evidence justifies planning and implementing a comprehensive clinical trial to convincingly validate this new potential therapeutic intervention.
 
The panel discussed various clinical research alternatives including the following:
 
       A controlled case series trial using currently available standardized speech assessment measures  or developing new clinical assessment profiles for baseline and post-EFA testing
 
     A randomized, placebo-controlled multicenter clinical trial of EFA and placebo supplementation to be undertaken as soon as possible.  For example, if a randomized, placebo-controlled clinical trial would be undertaken, all diagnosed verbal apraxic children, including those with hypotonia and sensory integration disorder, who have not been supplemented with EFAs, would be eligible for randomization.  The panel suggested that all randomized children would  be supplemented with EFA or placebo in addition to appropriate speech therapy.  This took into consideration the potential cooperative or possibly synergistic effect of the combined therapies in the treatment group.  The length of the trial is proposed to be 3 months.  Improvement in verbal communication skills, or the lack thereof using an assessment protocol as described above, would be the major therapeutic outcome measured, and plasma, as well as erythrocyte membrane EFA levels would be monitored periodically.  The two groups would consist of about 20-30 age-matched subjects. ProEFA would be the therapeutic supplement used in the trial based on preliminary successes attained.
 
In addition the panel noted the potential availability of electrophysiological measuring instruments that could serve as assessment tools of developmental-behavioral characteristics of a verbal apraxic child, and recommended the exploration of such techniques.  While the panel refrained from discussing the etiology and pathophysiology of verbal apraxia, it also expressed great interest in what appears to be a presence of verbal apraxia in a percentage of children on the autistic spectrum  and a possible association in other disorders and syndromes, such as: hypotonia, sensory integration disorder, dysarthria, attention deficit hyperactivity disorder, Kabuki Syndrome and cerebral palsy.  The panel recommended further exploration of these phenomena.
 
Although no final decision was reached on the nature of the clinical trial/trials to be undertaken, the workshop ended with a commitment from all members to continue debating this issue in close collaboration with the organizers, and to reach a decision within the shortest timeframe possible.
 
The organizers thank all panel members for their tireless dedication and enthusiastic participation in the Workshop's deliberations, and thank all parents who contributed to the success of the workshop, by requesting the professionals supervising and treating their children to complete a professional anecdotal case report questionnaire on the outcomes of EFA supplementation.  This workshop could not have taken place without their assistance.
 
The organizers also wish to acknowledge with thanks the assistance of many dedicated parents in helping with the logistic aspects of the workshop.
 
Last but not least, the organizers are thankful to the CHERAB Foundation's president, Ms. Lisa Geng, for her support of this workshop, and her boundless energy and enthusiasm in the service of verbal apraxic children and their parents.

The Scientific Organizers:

Marilyn Agin, M.D., and Robert Katz, Ph.D.,
 
Scientific Panel Members:
 
Marilyn Agin, M.D.
Medical Director, Early Intervention, New York City, NY
 
Susan E. Carlson, Ph.D.
Professor, University of Kansas, Kansas City, Kansas
Member Consortium for Fatty Acids (CFBFA)
 
Joseph Hibbeln, M.D.
Chief, Outpatient Clinic
National Institute of Alcoholism and Alcohol Abuse
NIH, Bethesda, Maryland

Robert Katz, Ph.D.
Managing Director, Consortium for Brain Fatty Acids (CFBFA) Omega-3 Research Institute, Inc.

 
Nancy Kaufman, M.A., CCC/SLP
Director, Kaufman Children's Center for
Speech Language and Sensory Disorders,
West Bloomfield,  Michigan
 
Ann Moser
Director, Peroxisomal Diseases
and Fatty Acid Profiles Clinical Laboratory,
Kennedy Krieger Institute, Baltimore, Maryland
Member CFBFA.
 
Jennifer Hill-Karrer, Ph.D.
Associate Professor,
University of Kansas Medical Centre, Kansas City, Kansas
 
Lori Roth M.A., CCC/SLP
Speech Pathologist, CHERAB Foundation
 
Andrew Zimmerman, M.D.
Professor, Johns Hopkins University and
Kennedy Krieger Institute, Baltimore, Maryland

 

Guest Panelist:
 
Alexandra J. Richardson, MA, DPhil
Senior Research Fellow in Neuroscience, Imperial College School of Medicine, MRI Unit, Hammersmith Hospital, London; and University Lab. of Physiology, Oxford.
Guest Dinner Speaker:
 
Hugo W. Moser, M.D.
University Professor, Johns Hopkins University School of Medicine Baltimore, MD Director of Neurogenics Department,
Kennedy Krieger Research Institute Baltimore, MD

 

The Administrative Organizers:

CHERAB Foundation

Lisa Geng, President, Suzanne Smolyar, Executive Vice President, and Glenn W. Geng Executive Director, Treasurer

For scientific details on the Conference please contact Dr. Robert Katz, President, Omega-3 Research Institute, Inc at the following e-mail address: omega3ri@aol.com  For all other information, please contact the CHERAB Foundation

How did this Apraxia /EFA Scientific Conference Come About? 

 

Official Statement from The First Scientific Conference Dedicated to the Therapy of Verbal Apraxia/Dyspraxia!  You may want to explore the archives of our grouplist.
 


Click to subscribe to childrensapraxianet A global source of support overseen by medical speech and educational professionals.

 

 

 

Send mail to Support with technical questions or comments about this web site. 
Copyright © 1998 
Last modified: Friday, June 03, 2005

To find your way around the CHERAB part of this site please click here for the index.

"Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." -- Margaret Mead, anthropologist

Send mail to Support with technical questions or comments about this web site. 
Copyright © 1998 
Last modified: Friday, June 03, 2005

To find your way around the CHERAB part of this site please click here for the index.

"Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has." -- Margaret Mead, anthropologist