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What is Limb Apraxia?

You can also read Khalid's story.  Khalid, featured on our "Success" page, was diagnosed with both verbal and limb apraxia.  Many children with verbal apraxia do NOT have limb apraxia, but it's always important to have a knowledgeable professional diagnose your child.

by Moira Kowalczyk 
Pediatric Occupational Therapist (OT)

"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, etc.  

In the 70's and 80's, OTs were very interested in dyspraxia and its relationship to learning disabilities.  An OT named "Jean Ayres" was the primary researcher in this area and she 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 a "SIPT"
certified therapist.  A child should ideally be of a mental age of about
5 years in order o 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 w/o 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 can not do this upon request or in imitation.  they might smile spontaneously but not in imitation/command , they might be able to lick peanut bitter off their 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);  they 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)
 
I hope this helps you sort through some issues that are typically seen with children that have general "motor incoordination" deficits (often associated with general developmental delays) vs. "pure" praxis problems that are a result of difficulties in the "planning" (or sequencing) phase of motor skills.
and to make matters worse(!!)  children with motor coordination deficits
can also have con-commitant motor planning problems but then the
situation requires a "multi-pronged" approach that would also deal with
strengthening and coordination training as well as planning and practice / drills approach.

For more information on global praxis/motor planning deficits, you might
want to look at the following web sites:

www.sinet.org

www.sii.org, (sensory integration international;  they will provide you
with specific info regarding therapists that have been certifies to
administer the SIPT.  this org was founded by Jean Ayres)  

If you have any more questions, please feel free to e-mail me
personally...

email- Moira Pediatric OT

 

 

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