Neuromuscular Disorders

Neuromuscular disorders affect the nerves that control your voluntary muscles. Voluntary muscles are the ones you can control, like in your arms and legs.

Neuromuscular disorders affect the nerves that control your voluntary muscles. Voluntary muscles are the ones you can control, like in your arms and legs. Your nerve cells, also called neurons, send the messages that control these muscles. When the neurons become unhealthy or die, communication between your nervous system and muscles breaks down. As a result, your muscles weaken and waste away. The weakness can lead to twitching, cramps, aches and pains, and joint and movement problems. Sometimes it also affects heart function and your ability to breathe.

Examples of neuromuscular disorders include

  • Amyotrophic lateral sclerosis
  • Multiple sclerosis
  • Myasthenia gravis
  • Spinal muscular atrophy

Many neuromuscular diseases are genetic, which means they run in families or there is a mutation in your genes. Sometimes, an immune system disorder can cause them. Most of them have no cure. The goal of treatment is to improve symptoms, increase mobility and lengthen life.

Apraxia is caused by damage to the brain. When apraxia develops in a person who was previously able to perform the tasks or abilities, it is called acquired apraxia.

The most common causes of acquired apraxia are:

  • Brain tumor
  • Condition that causes gradual worsening of the brain and nervous system (neurodegenerative illness)
  • Dementia
  • Stroke
  • Traumatic brain injury

Apraxia may also be seen at birth. Symptoms appear as the child grows and develops. The cause is unknown.

Apraxia of speech is often present along with another speech disorder called aphasia. Depending on the cause of apraxia, a number of other brain or nervous system problems may be present.

A person with apraxia is unable to put together the correct muscle movements. At times, a completely different word or action is used than the one the person intended to speak or make. The person is often aware of the mistake.

Symptoms of apraxia of speech include:

  • Distorted, repeated, or left out speech sounds or words. The person has difficulty putting words together in the correct order.
  • Struggling to pronounce the right word
  • More difficulty using longer words, either all the time, or sometimes
  • Ability to use short, everyday phrases or sayings (such as "How are you?") without a problem
  • Better writing ability than speaking ability

Other forms of apraxia include:

  • Buccofacial or orofacial apraxia. Inability to carry out movements of the face on demand, such as licking the lips, sticking out the tongue, or whistling.
  • Ideational apraxia. Inability to carry out learned, complex tasks in the proper order, such as putting on socks before putting on shoes.
  • Ideomotor apraxia. Inability to voluntarily perform a learned task when given the necessary objects. For instance, if given a screwdriver, the person may try to write with it as if it were a pen.
  • Limb-kinetic apraxia. Difficulty making precise movements with an arm or leg. It becomes impossible to button a shirt or tie a shoe.

The following tests may be done if the cause of the disorder is not known:

  • CT or MRI scans of the brain may help show a tumor, stroke, or other brain injury.
  • An electroencephalogram (EEG) may be used to rule out epilepsy as a cause of the apraxia.
  • A spinal tap may be done to check for inflammation or an infection that affects the brain.

Standardized language and intellectual tests should be done if apraxia of speech is suspected. Testing for other learning disabilities may also be needed.

People with apraxia can benefit from treatment by a health care team. The team should also include family members.

Occupational and speech therapists play an important role in helping both people with apraxia and their caregivers learn ways to deal with the disorder.

During treatment, therapists will focus on:

  • Repeating sounds over and over to teach mouth movements
  • Slowing down the person's speech
  • Teaching different techniques to help with communication

Recognition and treatment of depression is important for people with aprexia.

To help with communication, family and friends should:

  • Avoid giving complex directions.
  • Use simple phrases to avoid misunderstandings.
  • Speak in a normal tone of voice. Speech apraxia is not a hearing problem.
  • DO NOT assume that the person understands.
  • Provide communication aids, if possible, depending on the person and condition.

Other tips for daily living include:

  • Maintain a relaxed, calm environment.
  • Take time to show someone with apraxia how to do a task, and allow enough time for them to do so. DO NOT ask them to repeat the task if they are clearly struggling with it and doing so will increase frustration.
  • Suggest other ways to do the same things. For example, buy shoes with a hook and loop closure instead of laces.

If depression or frustration is severe, mental health counseling may help.

Many people with apraxia are no longer able to be independent and may have trouble performing everyday tasks. Ask the health care provider which activities may or may not be safe. Avoid activities that may cause injury and take the proper safety measures.