Apraxia: The Neural Network Model

ISBN-13: 9783031241048 / Angielski / Twarda / 2023 / 218 str.

Theodore Wasserman; Lori Drucker Wasserman

Opis

The work will be a reanalysis and reconceptualization of the concept of apraxia. Apraxia is currently understood as a motor speech disorder but an analysis of the neural network properties of apraxia indicate a more complex and far reaching disorder with implications for intentionality, motor coordination and motor control of response inhibition in a variety of human behavioral and emotional reactions. A thorough redefinition of apraxia will be provided along with suggestions for diagnoses and treatment. The primary audience will be diagnostic and treating professionals in a variety of disciplines (outlined above). Secondarily, the book will provide an argument and justification for considering developmental apraxia pf speech to be a separate and discrete white matter based disorder. Finally, this work will serve as a driver of future research in the area.

Spis treści

Chapter 1 The history of Apraxia

John Hughlings Jackson, though he did not provide the specific name, was the first to clearly describe apraxia in 1861 (Pearce, 2009). The term apraxia was first defined by Hugo Karl Liepmann in 1908 as the "inability to perform voluntary acts despite preserved muscle strength." In 1969, Frederic L. Darley (Strand, 2001) coined the term "apraxia of speech", replacing Liepmann's original term "apraxia of the glosso-labio-pharyngeal structures."  Today, apraxia of speech (AOS) is considered to be a motor speech disorder that can occur in the absence of aphasia or dysarthria. AOS has been the subject of some controversy since the disorder was first named and described by Darley and his Mayo Clinic colleagues in the 1960s. Our conceptualizations about apraxia have changed little since that time. While science has identified many different types of apraxia, the idea that unites the remains the inability to perform voluntary acts despite preserved muscle strength. This chapter will detail the history of the concept and culminate in a description of its modern day status.

Chapter 2 Traditional forms of Apraxia

This chapter will summarize the traditional forms of apraxia and provide a detailed description of the presumed classic neural etiology. There were, and to a large extent remain several different ways to define and categorize apraxic conditions. Each will be described. Descriptions of the following will be provided:

Limb-kinetic apraxia

People with limb-kinetic apraxia are unable to use a finger, arm, or leg to make precise and coordinated movements. Although people with limb-kinetic apraxia may understand how to use a tool, such as a screwdriver, and may have used it in the past, they are now unable to carry out the same movement.

Ideomotor apraxia

People with ideomotor apraxia are unable to follow a verbal command to copy the movements of others or follow suggestions for movements.

Conceptual apraxia

This form of apraxia is similar to ideomotor apraxia. People with conceptual apraxia are also unable to perform tasks that involve more than one step.

Ideational apraxia

People with ideational apraxia are unable to plan a particular movement. They may find it hard to follow a sequence of movements, such as getting dressed or bathing.

Buccofacial apraxia

People with buccofacial apraxia, or facial-oral apraxia, are unable to make movements with the face and lips on command.

Constructional apraxia

People with constructional apraxia are unable to copy, draw, or construct basic diagrams or figures.

Oculomotor apraxia

Oculomotor apraxia affects the eyes. People with this type of apraxia have difficulty making eye movements on command.

Verbal apraxia

People with verbal or oral apraxia find it challenging to make the movements necessary for speech. They may have problems producing sounds and understanding rhythms of speech.

This chapter will stress that traditional apraxic conditions were described based upon their functional deficits as opposed to the underlying neurological damage. It will lay the foundation for a discussion of a central motor system that serves as the core for all motor movement, even the motor movement associated with higher order cognition (Koziol, Budding, & Chidekel, 2012).

Chapter 3 Diagnosing Apraxia of Speech

At present, the diagnosis of AOS remains purely behavioral, based primarily on perceptual evaluation of speech characteristics without evaluation of brain tissue damage. This sometimes may result in confounding disorders with shared behavioral symptoms. However, in future apraxia evaluation may change as more is understood about what type of brain damage causes AOS and diagnosis may rely more heavily on evaluation of specific damage to brain regions important for speech. This chapter will provide a neuropsychological model of neural network functioning that may contribute to a new model of diagnosis of apraxia and related conditions.

 

Chapter 4 Apraxia, Dyspraxia and Aphasia

This chapter will discuss these three frequently confabulated conditions. It will first summarize dyspraxia and aphasia. In brief, it will describe the traditional notions that aphasia usually results from damage to part of the cerebral cortex, specifically Broca’s area and Wernicke’s area which are responsible for understanding and producing language. It will describe how people with aphasia may have difficulty:

• finding the right words to express themselves
• reading and writing sentences
understanding words and grammar

The chapter will go on to describe how in fact the two conditions may share some underlying neural network properties.

Dyspraxia which is classically described as a mild form of apraxia that people sometimes refer to as developmental coordination disorder. It reduces a person’s ability to do some physical movements, and on occasion, may also affect speech.

People with dyspraxia may have the following symptoms:

• difficulty with balance
• clumsiness
• vision problems
• emotional or behavioral difficulties
problems with social skills
• difficulty reading, writing, and speaking
• memory problems

Again the emphasis of this chapter will be to establish the reader’s comprehensive understanding of Apraxia and lay the foundation for the conceptual argument and research that is to follow.

Chapter 5 Developmental Apraxia

Developmental apraxia of speech (DAS) is a disorder of presumed neurological basis whose exact etiology has not been established. It is considered a disorder in the programming of sequential articulatory movements. This definition, based purely on motoric limitations, is controversial regarding etiology, clinical manifestations, treatment, and even identification of the disorder as a separate clinical entity.

An understanding of developmental apraxia depends on consistent utilization of a group of symptoms for diagnosis so that data-based results can be used to generate inferences about the disorder. That is where the science stands today. This chapter will lay the foundation for a discussion that developmental a neural network disorder where damage to the white mater transmission network is responsible for the result. It will also lay the foundation for the argument that the phonological and perhaps aphasic disorders that are differential diagnoses for apraxia have motoric components as well.

Chapter 6 Developmental versus acquired apraxia: Similarities and differences.

When apraxia is acquired as a result of an insult to the brain of an adult, it is much more likely that it is the result of damage to a specific and dedicated motor speech network. This is not the case when considering the etiology of developmental apraxia. The etiology of developmental apraxia has not been clearly established. This chapter will argue that the two conditions, despite their behavioral similarities, are sufficiently different to represent different disorders for the purposes of treatment and the understanding of impact. Therefore, it will be suggested that Developmental Apraxia of Speech should be a separate and discrete diagnosis.

Chapter 7 Neural Networks: a primer

This chapter will provide a review of neural network modeling and a discussion of its relevance for understanding Apraxia. Work from our previous research will be used as the basis of this chapter (Wasserman & Wasserman, Neural Netwroks Series, Therapy, 2019) (Wasserman & Wasserman, Neurocognitive Learning Therapy: Theory and Practice, 2017).

Chapter 8 Neural network properties of the motor speech system

This chapter will specifically the motor components of speech and language functioning from a developmental perspective. The chapter will put forward a model that identifies white matter disruption as the etiologic basis of this disorder.

Chapter 9 Apraxia’s are not isolated disorders

This chapter will demonstrate that most apraxias do not manifest in isolation. They represent a disruption of an integrated system of fine and gross motor movement and related skill specific networks. As such, a disruption of a core motor coordination transmission component will inevitably result in several motor areas being impacted at the same time. Since many of these motor networks are shared amongst specific skills it is likely that multiple disruptions of efficient functioning will take place, particularly in the case of developmental apraxia.

Chapter 10 Components of the motor network related to apraxia

This chapter will review in detail the cortical and subcortical structures that have been identified in research as associated with various forms of apraxia. This will include and extensive discussion of specific subcortical areas such as the cerebellum and the basal ganglia and how the traditional view of the contribution of these areas understates their importance. It will review Liepmann’s original descriptions at the beginning of the century, that hypothesized that apraxia was caused by damage confined to the cerebral cortex and/or cortico-cortical connecting pathways. This chapter will support the model that apraxia is a description of disorders of planning and execution of complex movements, irrespective of the site of pathology.  Current research will demonstrate how this view has evolve and specifically highlight the data demonstrating that subcortical structures play a key role in apraxic conditions.

Chapter 11 Differentiating white matter apraxic conditions from grey matter based apraxic conditions.

 This chapter will posit a different diagnostic system with two groups of apraxic conditions but talk in great specificity about apraxic conditions of emanating from white matter based connectivity.

Chapter 12 Brain Imaging and apraxia

This chapter will summarize the known research on brain imaging and the various types of apraxia. Special emphasis will be placed on the white matter, connectivity issues inherent in a neural network model of apraxia.

Chapter 13 Apraxia and Writing

This chapter will discuss dysgraphia and provide an understanding of this condition based on a network connectivity model involving motor coordination and other network components up to and including high order cognition.

Chapter 14 Developmental apraxia and Reading

This chapter will further differentiate developmental apraxia from other acquired apraxic conditions. Developmental apraxia implies a compromised motor coordination network whose operation forms the basis for a number of complex and necessary skills. One of the most important set of skills is reading and its foundational component, phonetic sequencing and decoding. The chapter will provide details on how these issues are related and provide suggestions on remediation strategies.

Chapter 15 Developmental apraxia and learning         

Children diagnosed with developmental apraxia of Speech often struggle with reading and comprehension. This is because if your child is having difficulties saying the sounds, they will also have difficulties reading the sounds. Other areas of learning arte also impacted. This chapter will review research on those learning elements impacted by apraxia.

Chapter 16 Summary and Concluding thoughts

This chapter will summarize a neural network understanding of how apraxia operates with special attention to the idea that developmental apraxia is perhaps an entirely different condition from acquired apraxia. Suggestions for future research will be provided.

O autorze

Dr. Ted Wasserman is board certified in clinical psychology by the American Board of Professional Psychology and board certified in pediatric neuropsychology by the American Board of Pediatric Neuropsychology. He is a member of the American Academy of Clinical Psychology and the American Academy of Pediatric Neuropsychology as a result of these board certifications. Dr. Wasserman, a Licensed Psychologist in the State of Florida, completed his doctorate at Hofstra University in 1974. He completed a one-year internship in pediatric neuropsychology at North Shore University Medical Center. Postdoctoral training was completed in Cognitive Behavior Therapy at the Institute for Advanced Study of Rational Psychotherapy under the supervision of Albert Ellis PHD. Dr. Wasserman holds memberships in the National Academy of Neuropsychology and the International Neuropsychological Society and is a founding member and past president of American Board of Pediatric Neuropsychology.

Dr. Wasserman is the co-author of two books, Depathologizing Psychopathology and Neurocognitive Learning Therapy: Theory and practice, published by Springer in 2017 and 2018 respectively. Dr. Wasserman has contributed chapters to various books on clinical issues related to family law, autism, and attention deficit disorder and learning disorders. Topics of published papers include children’s development, attention, language and executive function, behavior management and cognitive behavior therapy. He has given invited lectures and provided consultation regarding pediatric neuropsychology throughout the United States and internationally.

Lori Drucker Wasserman has been in clinical practice since 1982. Dr. Wasserman received her Bachelor of Arts degree from New York University and both her Masters and her Ph.D. in Clinical Psychology at Hofstra University. Dr. Wasserman is a licensed psychologist and is Board Certified in Pediatric Neuropsychology by the American Board of Pediatric Neuropsychology. She is also a certified School Psychologist. Dr. Wasserman is certified as a trained examiner for the Brazelton Neonatal Behavioral Assessment Scale.

Dr. Wasserman has worked at the Astor Day Treatment Center in the Bronx with children between the ages of 5 – 18 and the Early Intervention Program in Palm Beach County evaluating children between the ages of birth and three years.  She has extensive experience in the assessment, diagnosis and planning for children with special needs, emotional and educational concerns. Dr. Wasserman has also had extensive treatment experience in working with individuals across the life spectrum applying the practices of Neurocognitive Learning Therapy.  

Dr. Wasserman has co-authored two books on neuroscience and mental health, and has published multiple articles on the neuroscience of attention and executive function.