Stroke-Induced Apraxia: Understanding The Cause And Effect Relationship

can stroke causing apraxia

A stroke can cause apraxia, a cognitive disorder that prevents a person from carrying out learned movements. Apraxia is not due to muscle weakness or sensory loss but is instead a loss or disturbance of the ability to organise actions to achieve a goal. It can affect the ability to perform movements and gestures and can impact a person's ability to relearn movements or learn new skills after a stroke, affecting their recovery.

There are many different types of apraxia. The most common type is buccofacial (or orofacial) apraxia, which causes difficulty in making movements of the mouth, eyes or face. Limb apraxia, which affects the use of arms and legs, is also common and includes ideational apraxia (difficulty in organising actions to achieve a goal) and ideomotor apraxia (difficulty in selecting, sequencing and using objects).

Apraxia is most common among individuals with damage to the left parietal lobe but can also result from damage to the right parietal lobe, temporal lobe, frontal lobe or subcortical regions. It is often accompanied by aphasia, an impairment in the ability to use or comprehend words.

Characteristics Values
Prevalence Approximately 30% of individuals display apraxia or partial signs of apraxia (i.e. dyspraxia) following stroke.
Type Buccofacial (or orofacial), ideational, ideomotor, non-verbal oral, apraxia of speech, limb apraxia
Diagnosis Formal tests, observation of the patient's movements when imitating gestures, following spoken commands, or using common objects.
Treatment Strategy training for daily activities, gesture training, direct ADL training, using assistive technology to compensate for difficulties.
Prognosis Apraxia typically spontaneously recovers in the first few months post-stroke and is responsive to rehabilitation. The recovery process and rate of recovery will be different for each individual.

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Aphasia, apraxia of speech and oral apraxia are communication disorders that can result from a stroke

Aphasia, apraxia of speech, and oral apraxia are communication disorders that can result from a stroke. These conditions are often hard to distinguish between, and they can occur simultaneously.

Aphasia

Aphasia is a language disorder that impairs a person's ability to use or comprehend words. It can cause difficulty in understanding words, finding the right word to express a thought, understanding grammatical sentences, or reading and writing words or sentences. Therapeutic approaches for aphasia may include restoring language ability through word and picture matching, stimulating the ability to access words, and learning compensating communication methods such as gesturing or writing.

Apraxia of Speech

Apraxia of speech, also known as verbal apraxia, is a neurological disorder that affects the brain pathways involved in planning the sequence of movements required for speech production. It causes difficulty in initiating and executing the voluntary movement patterns necessary for producing speech, even though there is no paralysis or weakness in the speech muscles. Apraxia of speech may lead to challenges in producing desired speech sounds and using the correct rhythm and rate of speaking. Therapy approaches focus on teaching sound production and rhythm through repetitive practice and alternative communication systems.

Oral Apraxia

Oral apraxia, or nonverbal oral apraxia, involves difficulty in voluntarily moving the muscles of the lips, throat, soft palate, and tongue for purposes other than speech, such as smiling or whistling. It does not typically affect speech or swallowing and may not be treated by a speech-language pathologist.

While aphasia and apraxia share some similarities, such as difficulty in expressing oneself with words, they are distinct conditions. Aphasia primarily affects the ability to understand or use words effectively, impacting speaking, reading, and writing. On the other hand, apraxia is characterized by challenges in starting and completing the movements needed for speech, despite having the physical ability and understanding to do so.

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Aphasia is an impairment in the ability to use or comprehend words

Aphasia is a language disorder that impairs one's ability to use or comprehend words. It is often a result of damage to the language centres of the brain, typically caused by a stroke or traumatic brain injury. Aphasia can also be caused by progressive neurological conditions like dementia or Alzheimer's disease. It affects the ability to speak, read, write, and understand what others are saying.

Aphasia can manifest in several types, including:

  • Mixed transcortical aphasia
  • Progressive primary aphasia (PPA)
  • Transcortical motor aphasia
  • Transcortical sensory aphasia
  • Wernicke’s aphasia (receptive aphasia)

The symptoms of aphasia vary depending on the type but often include difficulty in finding and using expressive language, understanding language, and reading and writing.

Aphasia is distinct from apraxia, another condition that can result from a stroke. Apraxia is a neurological condition that affects the ability to make certain movements, despite having the understanding and desire to perform them. This is caused by damage to the brain that prevents it from forming and sending instructions to the body.

Apraxia of speech, also known as verbal apraxia, specifically affects an individual's ability to translate conscious speech plans into motor plans, resulting in limited and difficult speech. This is characterised by difficulty in connecting speech messages from the brain to the mouth.

While aphasia and apraxia are distinct conditions, they can and often do occur together.

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Apraxia of speech is the difficulty in initiating and executing voluntary movement patterns necessary to produce speech when there is no paralysis or weakness of speech muscles

Apraxia of speech (AOS) is a neurogenic communication disorder that affects an individual's ability to translate conscious speech plans into motor plans, resulting in limited and difficult speech ability. It is characterised by a slow speaking rate, lengthened sounds, and abnormal prosody, among other symptoms. Importantly, AOS does not affect the strength or movement of the speech muscles themselves but rather the brain's ability to control them.

AOS is a frequent result of left hemispheric stroke, with the most common sign being a struggle or effortful groping to speak. This is caused by difficulty in finding the correct position of the articulators (i.e. lips and tongue). Speech may be halting and contain sound substitutions, consonant and vowel distortions, omissions, additions, and repetitions. Those with AOS are often aware of their errors and will attempt to self-correct. In severe cases, individuals may be unable to produce even simple words, though interestingly, most people with AOS can produce common phrases or sayings, such as "How are you?" or "Thank you," without error.

AOS can be caused by impairment to parts of the brain that control muscle movement and speech, particularly the premotor cortex and adjacent precentral gyrus. It is most commonly triggered by vascular lesions but can also be caused by tumours and trauma. Stroke-associated AOS makes up about 60% of all reported acquired AOS cases, though only about 11% of stroke cases involve this disorder.

Therapy for AOS may include teaching sound and rhythm production through repetition and the use of external sources of control like metronomes or finger-snapping. Alternative or augmentative communication systems that require little to no speaking can also be implemented, ranging from low-tech solutions like pencil and paper to high-tech solutions like computer programs.

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Oral apraxia involves difficulty in voluntarily moving the muscles of the lips, throat, soft palate and tongue for purposes other than speech, such as smiling or whistling

Oral apraxia is a communication disorder that can result from a stroke. It involves difficulty in voluntarily moving the muscles of the lips, throat, soft palate, and tongue for purposes other than speech, such as smiling or whistling. This is because oral apraxia does not affect speech or swallowing, and therefore, it may not be treated by a speech-language pathologist.

Oral apraxia is distinct from aphasia, another communication disorder that can result from a stroke. Aphasia is an impairment in the ability to use or comprehend words. It may cause difficulty in understanding words, finding the right word to express a thought, understanding grammatical sentences, or reading or writing words or sentences.

Apraxia of speech, or verbal apraxia, is also distinct from oral apraxia. Verbal apraxia is the difficulty in initiating and executing voluntary movement patterns necessary to produce speech when there is no paralysis or weakness of speech muscles. It may cause difficulty in producing the desired speech sound or using the correct rhythm and rate of speaking.

It is important to distinguish between these three disorders as they can all result from a stroke and may present at the same time.

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Apraxia is a cognitive disorder that can occur after a stroke

There are many different types of apraxia, including:

  • Buccofacial (or orofacial) apraxia: difficulty making movements of the mouth, eyes or face.
  • Ideational apraxia: difficulty organizing actions to achieve a goal.
  • Ideomotor apraxia: difficulty selecting, sequencing and using objects.

Apraxia typically spontaneously recovers in the first few months post-stroke and is responsive to rehabilitation. The recovery process and rate of recovery will be different for each individual. Intervention can be customized to the presenting difficulties, and can include strategy training for daily activities, gesture training, direct ADL training, and the use of assistive technology to compensate for difficulties.

Communication problems are very common after a stroke, with around one-third of stroke survivors experiencing issues with speaking, reading, writing, and understanding what others say to them. Aphasia and apraxia of speech are two such communication problems that can occur. Aphasia affects your ability to speak and understand what others say, and can also impact your ability to read and write. Apraxia of speech, on the other hand, is when you can't move the muscles in your face, mouth or throat in the order you need to when you're speaking, making it difficult for others to understand you.

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Frequently asked questions

Apraxia is a cognitive disorder that can occur after a stroke. It is a neuropsychological deficit that prevents a person from carrying out a learned movement, but is not due to muscle weakness or sensory loss.

The most common type of apraxia is buccofacial (or orofacial) apraxia, which is difficulty making movements of the mouth, eyes or face. The most common forms of limb apraxia are ideational apraxia and ideomotor apraxia. Ideational apraxia is difficulty organizing actions to achieve a goal, while ideomotor apraxia is difficulty selecting, sequencing and using objects.

Apraxia affects a person's ability to perform movements and gestures, and can impact their ability to do rehab activities, communicate with others, and complete common tasks.

Apraxia is common after a stroke, with approximately 30% of people who have had a stroke displaying apraxia or partial signs of apraxia (dyspraxia). It is more common among people with damage to the left hemisphere of the brain, but can also result from damage to other parts of the brain.

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