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