Apraxia of Speech

What is apraxia of speech?

Apraxia of speech, also known as verbal apraxia or dyspraxia, is a speech disorder in which a person has trouble saying what he or she wants to say correctly and consistently. It is not due to weakness or paralysis of the speech muscles (the muscles of the face, tongue, and lips). The severity of apraxia of speech can range from mild to severe.


apraxia of speech

What are the types and causes of apraxia?
There are two main types of speech apraxia: acquired apraxia of speech and developmental apraxia of speech. Acquired apraxia of speech can affect a person at any age, although it most typically occurs in adults. It is caused by damage to the parts of the brain that are involved in speaking, and involves the loss or impairment of existing speech abilities. The disorder may result from a stroke, head injury, tumor, or other illness affecting the brain. Acquired apraxia of speech may occur together with muscle weakness affecting speech production (dysarthria) or language difficulties caused by damage to the nervous system (aphasia).
apraxia of speech
Developmental apraxia of speech (DAS) occurs in children and is present from birth. It appears to affect more boys than girls. This speech disorder goes by several other names, including developmental verbal apraxia, developmental verbal dyspraxia, articulatory apraxia, and childhood apraxia of speech. DAS is different from what is known as a developmental delay of speech, in which a child follows the "typical" path of speech development but does so more slowly than normal.
apraxia of speech
The cause or causes of DAS are not yet known. Some scientists believe that DAS is a disorder related to a child's overall language development. Others believe it is a neurological disorder that affects the brain's ability to send the proper signals to move the muscles involved in speech. However, brain imaging and other studies have not found evidence of specific brain lesions or differences in brain structure in children with DAS. Children with DAS often have family members who have a history of communication disorders or learning disabilities. This observation and recent research findings suggest that genetic factors may play a role in the disorder.

apraxia of speech


What are the symptoms?
People with either form of apraxia of speech may have a number of different speech characteristics, or symptoms. One of the most notable symptoms is difficulty putting sounds and syllables together in the correct order to form words. Longer or more complex words are usually harder to say than shorter or simpler words. People with apraxia of speech also tend to make inconsistent mistakes when speaking. For example, they may say a difficult word correctly but then have trouble repeating it, or they may be able to say a particular sound one day and have trouble with the same sound the next day. People with apraxia of speech often appear to be groping for the right sound or word, and may try saying a word several times before they say it correctly. Another common characteristic of apraxia of speech is the incorrect use of "prosody" -- that is, the varying rhythms, stresses, and inflections of speech that are used to help express meaning.
apraxia of speech
Children with developmental apraxia of speech generally can understand language much better than they are able to use language to express themselves. Some children with the disorder may also have other problems. These can include other speech problems, such as dysarthria; language problems such as poor vocabulary, incorrect grammar, and difficulty in clearly organizing spoken information; problems with reading, writing, spelling, or math; coordination or "motor-skill" problems; and chewing and swallowing difficulties.
apraxia of speech
The severity of both acquired and developmental apraxia of speech varies from person to person. Apraxia can be so mild that a person has trouble with very few speech sounds or only has occasional problems pronouncing words with many syllables. In the most severe cases, a person may not be able to communicate effectively with speech, and may need the help of alternative or additional communication methods.


apraxia of speech

How is it diagnosed?
Professionals known as speech-language pathologists play a key role in diagnosing and treating apraxia of speech. There is no single factor or test that can be used to diagnose apraxia. In addition, speech-language experts do not agree about which specific symptoms are part of developmental apraxia. The person making the diagnosis generally looks for the presence of some, or many, of a group of symptoms, including those described above. Ruling out other contributing factors, such as muscle weakness or language-comprehension problems, can also help with the diagnosis.

To diagnose developmental apraxia of speech, parents and professionals may need to observe a child's speech over a period of time. In formal testing for both acquired and developmental apraxia, the speech-language pathologist may ask the person to perform speech tasks such as repeating a particular word several times or repeating a list of words of increasing length (for example, love, loving, lovingly). For acquired apraxia of speech, a speech-language pathologist may also examine a person's ability to converse, read, write, and perform non-speech movements. Brain-imaging tests such as magnetic resonance imaging (MRI) may also be used to help distinguish acquired apraxia of speech from other communication disorders in people who have experienced brain damage.

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How is it treated?
In some cases, people with acquired apraxia of speech recover some or all of their speech abilities on their own. This is called spontaneous recovery. Children with developmental apraxia of speech will not outgrow the problem on their own. Speech-language therapy is often helpful for these children and for people with acquired apraxia who do not spontaneously recover all of their speech abilities.

Speech-language pathologists use different approaches to treat apraxia of speech, and no single approach has been proven to be the most effective. Therapy is tailored to the individual and is designed to treat other speech or language problems that may occur together with apraxia. Each person responds differently to therapy, and some people will make more progress than others. People with apraxia of speech usually need frequent and intensive one-on-one therapy. Support and encouragement from family members and friends are also important.

In severe cases, people with acquired or developmental apraxia of speech may need to use other ways to express themselves. These might include formal or informal sign language, a language notebook with pictures or written words that the person can show to other people, or an electronic communication device such as a portable computer that writes and produces speech.

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Gestational Diabetes

What is gestational diabetes?

Gestational diabetes, also known as gestational diabetes mellitus, GDM, or diabetes during pregnancy, is a type of diabetes that only pregnant women get. If a woman gets diabetes when she is pregnant, but never had it before, then she has gestational diabetes.
Normally, your stomach and intestines digest the carbohydrate in your food into a sugar called glucose. Glucose is your body’s main source of energy. After digestion, the glucose moves into your blood to give your body energy.
gestational diabetes
To get the glucose out of your blood and into the cells of your body, your pancreas makes a hormone called insulin. If you have diabetes, either your body doesn’t make enough insulin, or your cells can’t use it the way they should. Instead, the glucose builds up in your blood, causing diabetes, or high blood sugar.
gestational diabetes
Gestational diabetes happens in about 5 percent of all pregnancies, or about 200,000 cases a year in the United States.
gestational diabetes
How do I know if I have gestational diabetes?
Health care providers will test most women who have average risk for gestational diabetes when they are between 24-28 weeks pregnant.
If your risk is higher-than-average, your health care provider may test you earlier, possibly as soon as you know you are pregnant.
gestational diabetes
There are two approaches to testing for gestational diabetes:

gestational diabetes
In the one-step approach, a woman will fast for 4 to 8 hours. Then a health care provider will measure her blood sugar and will do so again 2 hours after she drinks a sugar drink. This type of test is called an oral glucose tolerance test.
In the two-step approach, a health care provider measures a woman’s blood sugar 1 hour after drinking a sugar drink. Women whose blood sugar is normal after 1 hour probably don’t have gestational diabetes. Women whose blood sugar is high after 1 hour will then have an oral glucose tolerance test to see if they have gestational diabetes.
Will gestational diabetes affect the baby?
Most women who have gestational diabetes give birth to healthy babies, especially when they control their blood sugar, eat a healthy diet, exercise, and keep a healthy weight.
In some cases, though, gestational diabetes can affect the pregnancy and baby. Some potential risks include:

gestational diabetes
The baby’s body is larger than normal—called macrosomia. A large baby may need to be delivered by a surgical procedure called cesarean section, instead of naturally through the vagina.
The baby’s blood sugar is too low—called hypoglycemia. Starting to breastfeed right away can help get more glucose to the baby. The baby may also need to get glucose through a tube into his or her blood.
The baby’s skin turns yellowish and the whites of the eyes may change color—called jaundice. This condition is easily treated and is not serious if treated.
The baby may have trouble breathing and need oxygen or other help—called Respiratory Distress Syndrome.
The baby may have low mineral levels in the blood. This problem can causes muscle twitching or cramping, but can be treated by giving the baby extra minerals
How is gestational diabetes treated?
Many women with gestational diabetes have healthy pregnancies and healthy babies because they follow a treatment plan from their health care provider.
Each woman should have a specific plan designed just for her needs, but there are some general ways to stay healthy with gestational diabetes:

gestational diabetes
Know your blood sugar and keep it under control – By testing how much sugar is in your blood, it is easier to keep it in a healthy range. Women usually need to test a drop of their blood several times a day to find out their blood sugar level.
Eat a healthy diet – Your health care provider can make a plan with the best diet for you. Usually controlling carbohydrates is an important part of a healthy diet for women with gestational diabetes because carbohydrates affect blood sugar.
Get regular, moderate physical activity – Exercise can help control blood sugar levels. Your health care provider can tell you the best activities and right amount for you.
Keep a healthy weight – The amount of weight gain that is healthy for you will depend on how much you weighed before pregnancy. It is important to track your both your overall weight gain and weekly rate of gain.
Keep daily records of your diet, physical activity, and glucose level – Women with gestational diabetes should write down their blood sugar numbers, physical activity, and everything they eat and drink in a daily record book. This can help track how well the treatment is working and what, if anything, needs to be changed.
Some women with gestational diabetes will also need to take insulin to help manage their diabetes. The extra insulin can help lower their blood sugar level. Some women might also have to test their urine to see if they are getting enough glucose.

What happens after the baby is born?
For most women, blood sugar levels go back to normal quickly after the baby is born. Six weeks after the baby is born, you should have a blood test to check your blood sugar levels. The test also checks for your risk of getting diabetes in the future.
If you know you want to get pregnant again, have a blood sugar test up to three months before becoming pregnant to make sure your blood sugar level is normal.
gestational diabetes
Children whose mothers had gestational diabetes are at higher risk for obesity, abnormal glucose tolerance, and diabetes.
gestational diabetes
Women who have had gestational diabetes and children whose mothers had gestational diabetes are at higher lifetime risk for obesity and type 2 diabetes. It may be possible to prevent type 2 diabetes through lifestyle changes. Talk to your health care provider about diabetes and increased risk from gestational diabetes.

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High Blood Pressure and Preeclampsia in Pregnancy

How Common Are High Blood Pressure and Preeclampsia in Pregnancy?

High blood pressure problems occur in 6 percent to 8 percent of all pregnancies in the U.S., about 70 percent of which are first-time pregnancies. In 1998, more than 146,320 cases of preeclampsia alone were diagnosed.
High Blood Pressure and Preeclampsia in Pregnancy
Although the proportion of pregnancies with gestational hypertension and eclampsia has remained about the same in the U.S. over the past decade, the rate of preeclampsia has increased by nearly one-third. This increase is due in part to a rise in the numbers of older mothers and of multiple births, where preeclampsia occurs more frequently. For example, in 1998 birth rates among women ages 30 to 44 and the number of births to women ages 45 and older were at the highest levels in 3 decades, according to the National Center for Health Statistics. Furthermore, between 1980 and 1998, rates of twin births increased about 50 percent overall and 1,000 percent among women ages 45 to 49; rates of triplet and other higher-order multiple births jumped more than 400 percent overall, and 1,000 percent among women in their 40s.

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High-Risk Pregnancy

High-Risk Pregnancy

What causes a high-risk pregnancy?
Before a woman becomes pregnant, it is important for her to have good nutrition and a healthy lifestyle. Good prenatal care and medical treatment during pregnancy can help prevent complications.
But there are factors that can be present before a woman becomes pregnant, that can cause a high-risk pregnancy. Risk factors for a high-risk pregnancy can include:
High-Risk Pregnancy
Young or old maternal age
Being overweight or underweight
Having had problems in previous pregnancies
Pre-existing health conditions, such as high blood pressure, diabetes, or HIV
Health problems can also develop during a pregnancy that can make it high-risk. Such problems may occur even in a woman who was previously healthy.
High-Risk Pregnancy
What are some conditions that may cause a high-risk pregnancy?
Preeclampsia and Eclampsia - Preeclampsia is a syndrome that includes high blood pressure, urinary protein, and changes in blood levels of liver enzymes during pregnancy. It can affect the mother’s kidneys, liver, and brain. With treatment, many women will have healthy babies. If left untreated, the condition can be fatal for the mother and/or the baby and can lead to long-term health problems. Eclampsia is a more severe form of preeclampsia that can cause seizures and coma in the mother.

High-Risk Pregnancy
Gestational Diabetes Mellitus (or gestational diabetes) is a type of diabetes that only pregnant women get. If a woman gets diabetes when she is pregnant, but never had it before, then she has gestational diabetes. Many women with gestational diabetes have healthy pregnancies and healthy babies because they follow a treatment plan from their health care provider.

High-Risk Pregnancy
HIV/AIDS kills or damages cells of the body's immune system, progressively destroying the body's ability to fight infections and certain cancers. The term AIDS applies to the most advanced stages of HIV infection.
Women can give HIV to their babies during pregnancy, while giving birth, or through breastfeeding. But, there are effective ways to prevent the spread of mother-to-infant transmission of HIV.
High-Risk Pregnancy
Preterm Labor is labor that begins before 37 weeks of pregnancy. Because the baby is not fully grown at this time, it may not be able to survive outside the womb. Health care providers will often take steps to try to stop labor if it occurs before this time.
Although there is no way to know which women will experience preterm labor or birth, there are factors that place women at higher risk, such as certain infections, a shortened cervix, or previous preterm birth.
High-Risk Pregnancy
Other medical conditions like high blood pressure, diabetes, or heart, breathing, or kidney problems can become more serious during a woman’s pregnancy. Regular prenatal care can help ensure a healthier pregnancy for a woman and her baby.
What can a woman do to promote a healthy pregnancy?
Many health care providers recommend that a woman who is thinking about becoming pregnant see a health care provider to ensure she is in good preconception health.
During pregnancy, there are also steps a woman can take to reduce the risk of certain problems:
High-Risk Pregnancy
Getting at least 400 micrograms of folic acid every day if she thinks she could become pregnant, and continuing folic acid when she does get pregnant
Getting proper immunizations
Maintaining a healthy weight and diet, getting regular physical activity, and avoiding smoking, alcohol, or drug use
Starting prenatal care appointments early in pregnancy

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