Medical Management of Children with Childhood Apraxia of Speech

This text-based course is a written transcript of the course, "Medical Management of Children with Childhood Apraxia of Speech" presented by Amy Newmeyer, M.D. on October 12, 2010

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This text is being provided by Communication Access Realtime Translation in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings.

>> Amy: Welcome to our first virtual conference, "Current Issues in Childhood Apraxia of Speech" in conjunction with University of Wisconsin Eau Claire. "Medical Management of Children with Childhood Apraxia of Speech" is presented by Amy Newmeyer. As you may know, today's seminar is a part of a week-long series of seminars on Childhood Apraxia of Speech and we're very pleased that all of you could join us today.

At this time it is an honor to introduce Dr. Amy Newmeyer. Amy Newmeyer is clinical Associate Professor of Pediatrics, section of Developmental and Behavioral Pediatrics at the Ohio State University College of Medicine. She is also Director of the Comprehensive CP Program and Director of the Developmental/Behavioral Pediatrics fellowship program at Nationwide Children's Hospital. She is a member of the Society for Pediatric Research Council. She is board certified in both general pediatrics and neurodevelopmental disabilities, and has evaluated children with CAS in an interdisciplinary team clinic for the last 8 years. So welcome, Dr. Newmeyer, thank you so much for joining us today.

Dr. Newmeyer: Thank you, Amy. I'm excited to do this. The interest that I have had in apraxia started about eight or 10 years ago. I'll talk a little bit about the specific condition that first interested me in apraxia, which is creatine deficiency. Along the way I've learned a lot from my speech pathology colleagues. What I would like to focus on today is my neurological approach and work approach when I see a child in my office with Childhood Apraxia of Speech.

Introduction

So I would like to review some of the common medical complications that we sometimes see in children with CAS, review reasons to consider a referral of a child with CAS for neurological evaluation, and review the medical testing protocol that I use to assess a child with CAS.

From a neurological perspective, what is apraxia? Apraxia is defined as an abnormality in the planning and performing of motor movements. Technically, apraxia can affect any type of motor skills that require sequencing of a series of events. This could be gross motor skills, fine motor skills or speech. And from the Greek, the "a" means "to do without" and the word "pratto" means "to do", so it actually translates into "without being able to do."

What is Apraxia?

There are a few different types of apraxia that we think about from a neurologic perspective. Ideational apraxia is a disturbance of voluntary movement in which a person misuses an object due to the difficulty identifying the concept or purpose behind an object. This is most commonly seen in adults that have had strokes. For instance, you may hand the person a comb or a brush. They wouldn't know to pick it up and brush their hair with it because they wouldn't understand what the object is for. But they would have fluid movement if they knew what the object was for and were able to perform the activity.

Ideomotor apraxia is the inability to carry out a command to mimic limb or head movements performed or suggested by others. This is usually where you see the movement that is not fluid or difficult to imitate and this is what we typically see in children. This can affect motor skills as well as speech.

There are two types of apraxia that we can think about when we think about children's speech disorders. The first is facial or oral apraxia; which is the inability to coordinate or carry out facial or lip movements such as whistling, winking or coughing. A common one we have children do in the office is to puff out their cheeks when they see us do it. The other type is verbal apraxia, which is the difficulty coordinating the mouth movements to coordinate speech sounds. This is the one that we're primarily talking about today.