Apraxia is considered a rare and difficult disorder, which makes it a great challenge for specialists and parents to deal with this problem in their children. This challenge becomes more complicated if apraxia is accompanied by other disorders such as autism, which makes it even more difficult. However, the insistence on overcoming these challenges is greater, and reaching solutions is not impossible. Thanks to insistence and effort, appropriate solutions can be found, and the most difficult obstacles can be overcome. In this article, we will review in Dalili Medical the most important points related to apraxia to help you, God willing.

**What is apraxia?**

 

Apraxia is a disorder that affects the ability to coordinate the movements necessary to produce speech, leading to difficulties in vocal and linguistic programming. Apraxia is a type of speech and pronunciation problem, where the muscles of the speech organs such as the jaw, lips and tongue are normal, but the child has difficulty controlling them sufficiently to coordinate sounds and pronunciation correctly. This condition is rare, and its causes are often neurological.

**Apraxia of speech in children**

 

Apraxia is most common in children and can significantly affect their language and social development. Children with this condition may have delayed speech or difficulty producing words and sentences clearly. Parents may also notice that the child struggles to speak, and may make unintelligible sounds or repeat syllables and words.

**Adult dysarthria**

 

Although dysarthria due to apraxia often begins in childhood, it can also appear in adults, usually as a result of a brain injury such as a stroke or a tumor. Adults with apraxia may have difficulty speaking clearly and understanding speech, which can negatively impact their daily life, work, and social relationships.

**The difference between apraxia and other speech disorders**

 

Dysarthria is similar to other disorders such as stuttering and dysarthria, but there are key differences between these conditions. In stuttering, a person has difficulty repeating or prolonging sounds, syllables, or words. Dysarthria is related to weakness in the speech muscles, which results in unclear or distorted speech. In contrast, the problem with apraxia is difficulty planning and executing speech movements, even if the speech muscles are functioning properly.

Types of apraxia:

1. **Developmental Apraxia**:   This is a condition that affects children without any known brain defect or disease.

2. **Acquired Apraxia**:   This condition affects individuals of all ages, but is more common in adults as a result of medical factors such as strokes, tumors, or encephalitis.

3. **Speech Apraxia**:   This is a speech disorder that affects a person's ability to produce and arrange sounds when asked. For example, a person may be asked to say the word "watermelon," but they make a mistake and say "cooking" instead, indicating an error in the arrangement of sounds.

4. **Apraxia related to the speech organs**: In this type, the person has difficulty moving the mouth, lips, and cheeks, which prevents him from performing various movements such as smiling or blowing when asked to do so.

5- Apraxia related to the limbs: In this type, the person has difficulty moving his limbs when asked, such as raising his hand, clapping, or performing other movements. Apraxia can be either developmental or acquired. Developmental apraxia appears as the child grows and develops in speech, and may be the result of an injury to the mother during pregnancy or for reasons related to the birth process itself. As for acquired apraxia, it appears as a result of a stroke or a brain tumor.

**Its characteristics:**

 

1. **Pronunciation characteristics:**- **Heart:** The heart is considered one of the most common mistakes, as the child pronounces a word such as "duck" as "taba". The heart is followed by other errors such as substitution, addition, and deletion of sounds.

- **Consonants:** Consonants such as "b, t, th, j, h, kh, d..." make a greater percentage of pronunciation errors than vowels such as "a, o, ay".

- **Syllable errors:** Errors increase in syllables and words that do not have a meaning.

- **Common words:** Words and phrases that are used frequently in everyday life are easier to pronounce, such as "hello", "good morning", and "thank you".

- **Inconsistent pronunciation:** A person may pronounce a word differently each time, such as pronouncing the word "library" as "taktaba" the first time and as "kakataba" the second time.

- **Error recognition:** A person realizes that they have made a mistake in speaking and tries to correct themselves.

- **Tone and speed:** Words that consist of more than one syllable are often slow in pronunciation.

- **Pronunciation prolongation:** Prolongation is observed in the pronunciation of consonants and vowels.

- **Syllable stress:** There is often equal stress on syllables.

2- Fluency in speech**

Fluency in speech includes repeating syllables and words when correcting errors. Some facial tension may appear when starting to speak, in addition to pausing before starting to speak and between syllables and words. If parents notice a number of these characteristics, they should consult a speech and language therapist to assess the problem, and if it is confirmed, training can be started later.

**Causes of difficulty in verbal performance**

 

The exact cause of apraxia is still not fully determined, but it is believed that there are several factors that may contribute to its appearance, including:

1. **Genetic factors**: Some research indicates a genetic predisposition to apraxia, as a family history of the condition can be observed in some cases.

2. **Brain injuries**: Brain injuries, such as stroke, tumors, or trauma, may lead toDamage to the areas responsible for planning and executing speech movements, causing apraxia of speech.

3. **Neurodevelopmental disorders**: Sometimes, apraxia of speech may be associated with other neurodevelopmental disorders, such as autism, cerebral palsy, or Down syndrome.

**Organic causes**

Include structural defects in the olfactory and central speech apparatus, such as malformations of the palate or tongue.

**Neurological causes**

Apraxia of speech can result from neurological disorders, such as cerebral palsy, or movement disorders such as Parkinson's disease.

**Developmental disorders** Some children may have a delay in language and speech development without any clear organic or genetic causes, a condition known as developmental apraxia of speech

**Communication disorders** Some communication disorders in children, such as autism spectrum disorder, can be accompanied by apraxia of speech.

**Environmental factors** Some environmental factors, such as neglect or exposure to violent experiences, contribute to delayed development of speech and language skills.

**Language learning disorders** Language learning disorders are factors that may contribute to the emergence of apraxia of speech.

**Symptoms of apraxia**

The symptoms of apraxia are many, but not all of them necessarily appear in the child, and some symptoms may be present in one child and not another. Here is a list of some of the symptoms that may appear:

**In very young children:**

 

- The infant may have difficulty babbling like other children of the same age.

- He is noticeably late in saying his first word (normal children usually begin saying their first word at around the age of one year).

- He produces a limited number of sounds, such as (b, m, aaa), while children of the same age can produce more diverse sounds such as (b, m, t, d, n, aaa, oooo, aeeee).

- Has difficulty producing syllables such as (dada, baba), as his production may be limited to single sounds such as (b, m), and when asked to imitate syllables such as (dada, bababab), he may not be able to do so and only produces the single sound (b, d).

- Has problems swallowing, which leads to frequent coughing after eating.

In older children:

Their understanding of language is much better than their ability to express it, as we find that the child understands almost everything (compared to his peers of the same age), but his vocabulary is limited to a limited number of words.

It may be difficult for people who hear him speak for the first time to understand what he is saying, while the family can easily understand him.

The child has difficulty imitating speech.

He may appear to be trying to remember the movements necessary to produce speech.

He has great difficulty pronouncing long, multi-syllable words compared to short words. For example, he can say words like "sleep", "get up", "bring", but he has difficulty saying long words like "two years", "our house", "we can", "we help", etc.

His speech becomes more difficult to understand when he is angry or stressed.

Some related problems include:

- Language delay, especially in productive language skills.

- Learning difficulties, as many children with apraxia have problems with reading and writing, and sometimes with math.

- Problems with sensory-motor coordination, such as building a tower of blocks, pouring water from a pitcher into a glass, or coloring inside a circle.

**Diagnosis of dysarthria or apraxia of speech**

Diagnosis of apraxia of speech (apraxia) depends on a comprehensive assessment of the individual's language and speech abilities, usually performed by a speech-language pathologist. This assessment includes several aspects:

1. **Observation of speech style**: The specialist observes the way the person speaks, including the clarity of speech, the ability to produce a variety of sounds and words, and the smoothness of speech.

2. **Sound and word imitation test**: The specialist asks the person to repeat specific sounds and words to assess their ability to control speech movements.

3. **Language comprehension assessment**: The specialist assesses the person’s ability to understand spoken and written language, to ensure that difficulties in speaking are not due to problems in understanding language.

4. **Exclusion of other causes**: The specialist may perform additional tests, such as hearing tests or brain imaging, to rule out any other possible causes that lead to speech difficulties.

**Complications of apraxia in children**

Many children with apraxia have additional problems that affect their ability to communicate. These problems are not caused by apraxia itself, but they appear alongside it. Some of the symptoms or problems that often accompany apraxia in children include: language delays, such as difficulty understanding speech, limited vocabulary, or difficulty using correct grammar when forming phrases and sentences. Intellectual and motor development may also be delayed, in addition to difficulties with reading, spelling, and writing. Children may also face challenges with fine and gross motor skills or coordination. In addition, they may have hypersensitivity to certain types of fabrics or the texture of certain foods, or they may have difficulty brushing their teeth.

**Supporting a child with apraxia**

 

The role of parents is essential in supporting a child with apraxia. Here are some tips that may be helpful:

**Encouragement and patience:** It is important to be patient and encouraging with your child, while providing them with many opportunities to talk and express themselves, even if their speech is unclear. Celebrate any progress they make, no matter how small.

**Clear communication:** Speak slowly and clearly to your child, using short, simple sentences that are easy to understand. Avoid complex language or difficult terms.

**Active listening:** Give your child time to express themselves, and listen carefully even if they are not clear. Try to understand what they are trying to say through their facial expressions and body language.

**Working with a speech therapist:** Work closely with your speech therapist toMonitor your child’s progress and implement the recommended home exercises. You may need to attend therapy sessions with your child to participate in the exercises and learn how to support them at home.

**Provide a supportive environment:** Create a supportive and encouraging home environment where your child feels comfortable and safe to speak and express themselves without fear of judgment or ridicule. Encourage them to interact with others, and provide them with opportunities to participate.

**Education and awareness**: It is important to educate yourself about apraxia of speech, as well as to educate family members, teachers, and friends about your child’s condition. This will help create a supportive environment for the child and reduce the likelihood of misunderstandings.

**Treatment of apraxia of speech**

 

Treatment of apraxia of speech depends on the underlying cause of the condition and its severity, and can include a variety of methods and techniques. Here are some common treatments for apraxia of speech:

- **Physiotherapy**: This type of treatment includes techniques aimed at improving control of fine muscle movements of the mouth and tongue. These techniques may include exercises to strengthen muscles and enhance motor coordination.

- **Speech and language therapy**: This therapy aims to improve an individual's ability to form words correctly and increase their understanding of spoken language. The therapy involves practicing phonetics and language sounds on a regular basis.

- **Assistive technology therapy**: Technologies such as computers and software that enhance verbal communication can help alleviate the difficulties faced by people with apraxia of speech.

**Psychotherapy**: Psychotherapy is an effective way to deal with the emotional and psychological challenges associated with the condition, and it also contributes to enhancing self-confidence and improving social interaction.

**Support and guidance for the family**: Providing support and guidance to family members is very important, as it helps provide emotional and cognitive support to the person suffering from apraxia of speech, which helps them face the challenges they may face.

**Guidelines for treating apraxia**

Parents can follow a set of guidelines to help their children, including:

1. Start with common words and phrases in everyday life to encourage the child to speak.

2. Divide words into syllables and pronounce each syllable separately while prolonging the sound, such as: "car" is pronounced "s" "ya" "ra".

3. Knock on the table while pronouncing each syllable.

4. Link auditory and visual stimuli, such as pronouncing the word "sun" while showing a picture of the sun, or if the child is good at reading, parents can pronounce the word and write it on a card.

5. Prepare a set of familiar pictures in the environment and ask the child to name them.

6. Give the child enough time to speak and answer without pressuring him to hurry up.

7. Reinforce the child when he gives a correct response.

8. Repeat the word at different times without forcing the child to repeat it.

** Exercises to strengthen the muscles of the speech organs**

Exercises to strengthen the lower jaw and mouth

A- Chin:

1- Open and close the mouth slowly.

2- Open and close the mouth quickly.

3- Open the mouth and eyes at the same time.

B - Lips:

1- Push the lips forward and then pull them back tight.

2- Pull the lips into the mouth.

3- Move the lips in a vibrating manner.

**C - Tongue:**

1. Extend the tongue out quickly and then return it to the mouth quickly.

2. Extend the tongue out quickly and then return it to the mouth slowly.

3. Extend the tongue out slowly and then return it to the mouth slowly.

4. Extend the tongue out slowly and then return it to the mouth quickly.

5. Move the tongue in a circular motion around the lips, starting from the left side and slowly.

6. Move the tongue in a circular motion around the lips, starting from the right side and slowly.

7. Move the tongue to specific areas inside and around the mouth, such as the teeth, the roof of the mouth, and the lips.

8. Extend the tongue over the lower lip as far as possible.

9. Extend the tongue over the upper lip as far as possible.

10. Insert the tongue between the lips and teeth and move it in a circular motion.

11. Show the tongue a little and make a groove out of it.

12. Move the tongue up and down while making a "la la la la" sound.

13. Place the tip of the tongue on the upper front teeth with the mouth open.

14. Place the tip of the tongue on the gums of the upper front teeth with the mouth open.

15. Place the back of the tongue on the roof of the mouth with the mouth open.

16. Stretch the tongue until it becomes thin and then return it to its normal position.

17. Let the tongue relax inside the mouth and then pull it back until it contracts.

**D - Vocal cords:**

1- Imitating the movements and sounds of pets or beloved animals, such as: the sound of a cat, dog, sheep, chicken, etc.

2- Imitating the movements and sounds of familiar machines and equipment, such as: the sounds of airplanes, cars, trains, hammers, flutes, telephones, bells, alarm clocks, etc.

3- Imitating human movements and sounds, such as: men's and women's voices, children's screams and laughter, songs, the call to prayer, and Quran recitation, etc.

In other words, this preparation program aims to enhance the child's ability to compare and develop familiarity between things, ideas, and movements. When the child becomes ready and accustomed to these exercises, we can work with him more effectively.

**Exercises to strengthen the respiratory system and speech organs**

**(1) Breathing exercises:** Breathing exercises should be practiced in order to expand the chest and activate the vocal cord muscles, in addition to training the mouth to exhale. The breathing process should be organized so that inhalation is done through the nose with the mouth closed and the shoulders fixed, while exhalation is done through the mouth with an audible sound.

**Exercise (1)** Lie on your back completely freely, without any restrictions that hinder your movement. Then breathe deeply and slowly through your nose, and you will feel the ribs expanding and the abdomen bulging forward, while the collarbones remain fixed. After taking in the air, pause for a moment and then exhale the air from your mouth forcefully and audibly.

**Exercise (2)** Inhale the air quickly and then exhale it slowly. To assess your progress, you can place a lit candle in front of your mouth and watch the movement of the flame to determine your ability to controlExhale.

**Exercise (3)**

Fast absorption and fast exhalation.

**Exercise (4)**

Slow absorption and slow exhalation.

There are also respiratory exercises used to train the production of some letter sounds, such as the sound /فـ /. The teacher can place a candle in front of the child and move it at different distances, and ask him to blow out the candle. The goal of the movement is to expand the lungs by exhaling the largest possible amount of air.

**Exercises to strengthen the mouth muscles and control their movements**

These exercises include movements of the jaws, lips and tongue in various positions and formations.

**Exercises to strengthen the uvula and make it more mobile:** You can practice yawning and laughing, in addition to blowing into tubes or any similar tools. Fill your mouth with air and then blow into your cheeks, after that pronounce a vowel such as the letter ha, which helps raise the uvula thanks to the resulting pressure.

**Exercises to strengthen the throat, activate the vocal muscles, and train the muscles of pronouncing letters:**

a) Take a deep breath and then exhale forcefully from your mouth, and repeat this several times.

b) Press your jaws, then open your lips and repeat the word "huh" several times.

c) Open your mouth as wide as possible and repeat the word "ah" several times, once in a low voice, once in a high voice, and once through the nose, in order to move the sources of letters such as the cavity, throat, tongue, lips, and nostrils.

d) Open your mouth while speaking, making sure that the parts of the mouth are relaxed.

e) Read aloud and focus on the letters that are weak.

**How ​​to enhance the pronunciation skills of your child with special needs**

**(1) Oral exercises** (each exercise should be done three times a day, for 10 to 20 minutes, using a mirror to help)

**1. Tongue exercises:** (Note: Avoid using the jaw to support the tongue during exercises)

**(A) Exercises for the entire tongue:**

A- Stick out the tongue and direct it to the right as far as possible.

B- Stick out the tongue and direct it to the left as far as possible.

C- Move the tongue out and in as far as possible.

D- Move the tongue right and left quickly until it reaches the sides of the mouth.

C- **Elephant trunk exercise:**

- Move the tongue out and up towards the nose (you can put a piece of sugar on the upper lip).

- Move the tongue out and down until it reaches the chin (you can put a piece of sugar on the lower lip).

**Licking training:** - Move the tongue on the sides of the upper lips from right to left, then vice versa. (You can put scattered sugar on the sides of the upper lips so that the child can lick them).

- Move the tongue under the sides of the lower lips from right to left, then vice versa. (You can put scattered sugar under the sides of the lower lips so that the child can lick them).

- Move the tongue as if it is licking everything around it in a circular motion. (You can put sugar around the entire mouth to facilitate this task).

**Pushing training:**

- Place your finger on the child's right cheek, then ask him to push your finger with his tongue.

- Place your finger on the child's left cheek, then ask him to push your finger with his tongue.

**(2) Tongue tip exercises**

A- Move the tip of your tongue up until it reaches the roof of the mouth. (Imagine that you are putting sugar on the roof of the mouth).

B- Move your tongue out, then move its tip up and down.

C- Obesity exercise:

- Move the tip of your tongue up under the upper lip. (As if you are trying to enlarge the upper lip).

- Move the tip of your tongue up under the lower lip. (As if you are trying to enlarge the lower lip).

D- Close the child's mouth, then ask him to put the tip of his tongue under his front teeth to feel how hard his teeth are.

**(3) Exercises for the middle and back of the tongue**

A- Hit your tongue against the roof of the mouth.

B- Move your tongue outward, then insert it as far as possible.

C- Pronounce the syllable "ka".

D- Pronounce the syllable "ja".

C- Pronounce the syllable "aj".

H- Swallow your saliva forcefully.

**(2) Jaw exercises**

A- Open your mouth as far as possible, then close it.

B- Chew your food with movements greater than usual.

**(3 Lip Exercises**

X- Press your lips together tightly.

D- Press your lips together tightly, then open them suddenly and forcefully while saying "b".

D- Place your lower lip over your upper lip, and pull it down (using your lip muscles, not your hands).

R- Smile exaggeratedly while saying "e-y-y-y".

G- Make a sucking motion with your lips as if you were kissing.

S- Rotate your lips as if you were whistling, while saying "oo".

S- Move your lips to the right and then to the left.

S- Puff out your cheeks by holding the air inside your mouth, then slowly exhale the air.

D- Practice the following vowel sounds:

- Long vowels: "و" "ا" "ي"

- Short vowels: فتحة, ضمة, كسرة.