Dyspraxia

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Dyspraxia
Classification & external resources
ICD-10 F82.
ICD-9 315.4

Dyspraxia is the partial loss of the ability to coordinate and perform certain purposeful movements and gestures in the absence of motor or sensory impairments. Dyspraxia may be acquired (e.g. as a result of brain damage suffered from a stroke or other trauma), or associated with failure / delay of normal neurological development - i.e. developmental dyspraxia.

The term apraxia is more often used to describe this symptom in clinical practice, although strictly apraxia denotes a complete (as opposed to partial) loss of the relevant function. In the UK and elsewhere the term dyspraxia is now more often used as shorthand for 'developmental dyspraxia' in referring to one or all of a heterogeneous range of disorders affecting the initiation, organization and performance of action[1].

Contents

[edit] Developmental dyspraxia

Developmental dyspraxia (referred to as developmental coordination disorder, DCD, in the US) is a life-long condition that is more common in males than in females, and has been believed to affect 8% to 10% of all children (Dyspraxia Trust, 1991). Ripley, Daines, and Barrett state that 'Developmental dyspraxia is difficulty getting our bodies to do what we want when we want them to do it', and that this difficulty can be considered significant when it interferes with the normal range of activities expected for a child of their age. Madeline Portwood makes the distinction that dyspraxia is not due to a general medical condition, but that it may be due to immature neuron development. The word "dyspraxia" comes from the Greek words "dys" meaning bad and "praxis", meaning action or deed.

Part of a continuum of related disorders, dyspraxia is also known as developmental coordination disorder, and may also be present in people with autism spectrum disorder, dyslexia and dyscalculia, among others. Dyspraxia is described as having two main elements:

Ideational dyspraxia 
Difficulty with planning a sequence of coordinated movements.
Ideo-Motor dyspraxia 
Difficulty with executing a plan, even though it is known.

[edit] Assessment and diagnosis

Assessments for dyspraxia typically require a developmental history, detailing ages at which significant developmental milestones, such as crawling and walking, occurred. Motor skills screening includes activities designed to indicate dyspraxia, including balancing, physical sequencing, touch sensitivity, and variations on walking activities. A baseline motor assessment establishes the starting point for developmental intervention programs. Comparing children to normal rates of development may help to establish areas of significant difficulty.

[edit] Developmental Profiles

There are six main areas of difficulty which can be profiled within dyspraxia; the four main areas are listed below:

[edit] Speech and language

Developmental verbal dyspraxia is a type of ideational dyspraxia, causing linguistic or phonological impairment. Key problems include:

  • Difficulties controlling the speech organs.
  • Difficulties making speech sounds
  • Difficulty sequencing sounds
    • Within a word
    • Forming words into sentences
  • Difficulty controlling breathing and phonation.
  • Slow language development.
  • Difficulty with feeding.

[edit] Fine Motor Control

Difficulties with fine motor co-ordination lead to problems with handwriting, which may be due to either ideational or ideo-motor difficulties. Problems associated with this area may include:

  • Learning basic movement patterns.
  • Developing a desired writing speed.
  • The acquisition of graphemes – e.g. the letters of the Latin alphabet, as well as numbers.
  • Establishing the correct pencil grip
  • Hand aching while writing

[edit] Whole body movement, coordination, and body image

Issues with fine motor coordination mean that major developmental targets include walking, running, climbing and jumping are affected. One area of difficulty involves associative movement, where a passive part of the body moves or twitches in response to a movement in an active part. For example, the support arm and hand twitching as the dominant arm and hand move, or hands turning inwards or outwards to correspond with movements of the feet. Problems associated with this area may include:

  • Poor timing
  • Poor balance
  • Difficulty combining movements into a controlled sequence.
  • Difficulty remembering the next movement in a sequence.

[edit] Physical play

Difficulties in areas relating to physical play may lead to dyspraxic children standing out from their peers. Major developmental targets include ball skills, use of wheeled toys and manipulative skills, including pouring, threading and using scissors.

  • Problems with spatial awareness, or proprioception
  • Mis-timing when catching
  • Complex combination of skills involved in using scissors

The other two developmental profiles concern dressing and feeding.

[edit] General difficulties

Due to poor muscle control, many people with dyspraxia have trouble picking up and holding onto simple objects [2] -- quite often, objects literally slip through a dyspraxic's fingers. This disorder causes an individual to be clumsy to the point of knocking things over and bumping into people accidentally. Tripping over one's own feet is also not uncommon, as is a poor sense of balance in general. [3]

Dyspraxics often have difficulty in determining left from right, and this may cause problems that persist through life[citation needed]. Cross-laterality, ambidexterity, and a shift in the preferred hand are also common in people with dyspraxia[citation needed].

Some people with this condition have poor spatial awareness in that it may be difficult to determine the speed and position of a particular object, such as potentially a baseball. Dyspraxics may also have trouble determining the distance between them and other objects.

Dyspraxic people may have Sensory Integration Dysfunction, a condition that creates abnormal oversensitivity or undersensitivity to physical stimuli, such as touch, light, and sound[citation needed]. This may manifest itself as an inability to tolerate certain textures such as sandpaper or certain fabrics, or even being touched by another individual (in the case of touch oversensitivity) or may require the consistent use of sunglasses outdoors since sunlight may be intense enough to cause discomfort to a dyspraxic (in the case of light oversensitivity). An aversion to loud music and naturally loud environments (such as clubs and bars) is typical behavior of a dyspraxic individual who suffers from auditory oversensitivity, while only being comfortable in unusually warm or cold environments is typical of a dyspraxic with temperature oversensitivity. This typically occurs if the dyspraxia is comorbid to an autistic spectrum disorder (PDD) such as autistic disorder or Asperger syndrome[citation needed]. Otherwise, these symptoms tend not to be present in the individual who has dyspraxia[citation needed].

Dyspraxic people sometimes have difficulty moderating the amount of sensory information that their body is constantly sending them, so as a result these people are prone to panic attacks[citation needed]. Having other autistic traits (which is common with dyspraxia and related conditions[citation needed]) may also contribute to sensory-induced panic attacks.

Dyspraxics (along with people who have similar conditions) may have difficulty sleeping since there is an inability to force the brain to stop thinking and "shut down"[citation needed]. A dyspraxic is nearly always thinking about several unrelated things at once, (the inverse is also possible, with only one dominant thought occupying the dyspraxic's entire attention span at any given time) so this may cause easy distractibility and daydreaming[citation needed]. It is quite easy for someone with dyspraxia to concentrate entirely on a particular thought instead of on the situation at hand. For this reason, dyspraxia may be misdiagnosed as ADHD since on the surface both conditions have similar symptoms in some areas[citation needed]. Many people with dyspraxia have short-term memory issues and may forget instructions they received only seconds before, tend to forget important deadlines, and are constantly misplacing items[citation needed].

Moderate to extreme difficulty doing physical tasks is experienced by dyspraxics, and fatigue is common because so much extra energy is expended while trying to execute physical movements correctly [4]. Some (but not all) dyspraxics suffer from hypotonia, which in this case is chronically low muscle tone caused by dyspraxia[citation needed]. People with this condition have very low muscle strength and endurance (even in comparison with other dyspraxics) and even the simplest physical activities may quickly cause soreness and fatigue, depending on the severity of the hypotonia. Hypotonia may worsen a dyspraxic's already poor balance to the point where it is necessary to constantly lean on sturdy objects for support[citation needed].

[edit] Overlap With Other Conditions

Dyspraxics can have other difficulties which are not part of dyspraxia itself but part of other conditions that often co-exist with dyspraxia. They may have characteristics of dyslexia (difficulty with reading and spelling), dyscalculia (difficulty with Mathematics) ADHD (poor attention span), or Aspergers Syndrome (poor social cognition, and a literal understanding of language, making it hard to understand idioms or sarcasm). However, they probably won't have problems in all of these areas. The pattern of difficulty varies widely from person to person, and it is important to understand that what is a major area of weakness for one dyspraxic can be a major area of strength, or even a gift, for another. For example, some while some dyspraxics have difficulty with reading and spelling due to an overlap with dyslexia, or numeracy due to an overlap with dyscalculia, others are may have brilliant reading and spelling or mathematical abilities. Similarly, some have autistic traits such as lacking an appreciation of irony or social cues, while others thrive on an ironic sense of humour as a bonding tool and a means of coping in adversity. [5]

Problems that are common to many dyspraxics whatever their profile of difficulties are frustration and low self-esteem [6].

[edit] Other Names

Collier first described dyspraxia as 'congenital maladroitness'. A. Jean Ayers referred to it as a disorder of sensory integration in 1972 while in 1975 Dr Sasson Gubbay called it the 'clumsy child syndrome' [7]. It has also been called minimal brain dysfunction although the two latter names are no longer in use. Other names include:

  • Developmental Co-ordination Disorder
  • Sensorimotor dysfunction
  • Perceptuo-motor dysfunction
  • Motor Learning Difficulties

The World Health Organisation currently lists dyspraxia as Specific Developmental Disorder of Motor Function [8].

[edit] References

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    [edit] External links

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