Apraxia…What is it and WHY does it matter?

As a speech pathologist treating kiddos and adults, sometimes words that are spoken just don’t make sense.  This may be a result of Apraxia – a motor disorder affecting the nervous system.   

A child may be seen having trouble placing his lips together to begin speaking.  Or, maybe he/she pauses and appears as if he/she is groping for sounds.  Difficulty imitating an adult’s speech may also be a sign of Childhood Apraxia. 

An adult may demonstrate a very SLOWWWW rate of speech and have difficulty imitating non-speech movements such as sticking out their tongue.   

Children & Adults can also show signs of apraxia affecting their gross and fine motor movements.  Sometimes walking while swinging their arms in a pattern increases fall risk.  Sometimes coordinating muscle movements to zip a coat, brush their teeth, or put on socks is affected.  Regardless of the activity, sequencing motor movements is EXTREMELY important as it affects how our body parts communicate to each other.   

WHY does it matter?  Regardless of the age of my patients, I have to take into consideration “IS THIS APRAXIA” and is it affecting other parts of their daily lives?  Speech pathology intervention can address sequencing of motor movements to improve speech sounds and word formations.  If a referral to physical or occupational therapy is necessary, I will make the referral.  However, if apraxia is not assessed and addressed, speech, language and voice function will likely NOT improve.  A strong clinician will not only make the diagnosis, but also help find strategies to move beyond it.   

Apraxia does matter.  At all levels: mild to severe!  If traditional speech and voice therapy intervention is NOT working, ask your clinician: Could this be a form of Apraxia? 

Everyone Has a Pelvic Floor

What is your “pelvic floor” and how do I know it is not working properly?

Good thing is that EVERYONE has a pelvic floor, no matter what pronoun or gender you identify with.

It is a total of 3 layers of muscles along your pelvis that help keep your bladder and reproductive organs supported, your bladder and bowel functioning, and for sexual activities to be possible.

Whenever someone works on their “core” they need to keep their pelvic floor in mind as your “core” is actually 4 muscle groups that work together with your diaphragm on the top, deep abdominal muscle in the front, deep back muscle in the back and pelvic floor muscles on the bottom.  These all needs to be training at the same time to really be working on your “core.” A pelvic floor therapist can help you coordinate your core to it is fullest potential.  It’s more than 6-pack abs!

“I pee a little when I jump or run, that’s just normal for my age.” WRONG!!  This is not normal.  This is your body, and specifically, your pelvic floor telling you that something is either too tight or too weak and needs to be assessed by a pelvic floor specialist to reduce any further issue and risk of infection. Wearing a diaper or brief is not a normal part of aging, nor should you let it be!

So, some factoids for a “normal” functioning pelvic floor for bladder and bowel health:

1. Normal urination frequency is ranging from 6-10 or up to 12 times per day (https://www.bladderandbowel.org/bladder/bladder-conditions-and-symptoms/frequency/).

2. Normal bowel frequency is ranging from 3 times per day to 3 times for week (https://www.bladderandbowel.org/bowel/bowel-resources/how-the-bowel-works/). 

3. Hydration recommendation is up to ½ your body weight in ounces in fluids per day, with most of that being water.  Quick math, if you weigh 200lbs, recommended 100 ounces of fluids with most of that (60-80%) being water.  Some of this can come from fluid filled fruits and veggies and some good hydration.  Be careful of how much caffeine and juices you have as they often have high sugar, salt and acidic that can cause detrimental effects on your bladder and gut (https://www.bladderandbowel.org/bladder/bladder-resources/lifestyle-fluids-and-diet/). 

Lastly, do you hold your stress in your neck, shoulders, or low back?  I bet you also hold your stress in your pelvic floor too.  Many of us who are highly stressed in the DC Metro area are always trying to find that work-life balance and “downtime.”  Well, your pelvic floor needs that too!  Often, down-training is what pelvic floor therapists work on with clients that may have pelvic floor dysfunction rather than continue to turn on or activate the already stressed muscle group.  Just because a muscle is shortened and activated all the time, does not mean it is strong.  Conversely just because a muscle is lengthened and stretched, does not mean it is flexible. Breathing techniques and postural training are used to help coordinate relaxation of the pelvic floor musculature in order to reduce pain, tightness, and possibly encourage a full muscle contraction.

Aching Knees Slowing You Down?

As we sit here in the cold of winter it is hard to believe but warmer weather will come.  People will begin to dust off the golf clubs or garden trowels and prepare to head outside and enjoy the sun.  Unfortunately for many people, their fun in the sun is curtailed due to chronic knee pain from osteoarthritis. In the US, it is estimated that over 6 million people ages 45 to 65 years have pain and other symptoms related to knee osteoarthritis (OA).

 OA is a progressive disease that damages the slippery cartilage located on the end of bones. This cartilage cushions the joints and helps it move smoothly and freely. As the cartilage is damaged and wears away, the contact of bone on bone can create pain, especially during weight-bearing activities like walking.  The symptoms of OA include persistent pain in the knee, stiffness with movement in the morning, snapping or popping sound in knee when moving, swelling, and decreased range of motion. Unfortunately, as pain increases people, tend to move less creating muscle weakness, decreasing endurance, and increasing their risk of falling. 

 Many believe the only way to treat knee OA is with surgery, but according to a 2013 analysis published in the New England Journal of Medical, research suggests that in many cases there is little difference in improvement of pain and functional levels of patients who chose physical therapy alone versus patients who chose corrective surgery (specifically an arthroscopic partial meniscectomy).

 In physical therapy, you will receive a full review of your symptoms, any X-rays/MRIs, along with a review of your past medical history.  In addition, the physical therapist will analyze your gait (how you walk) and assess your current strength and range of motion.  Following your comprehensive assessment, your therapist can create a treatment plan specific to your needs and goals. 

Your one on one sessions will include strengthening of the muscles that surround the knee to improve support of the knee joint.  Tight muscles often create a pull across the joint increasing pain therefore stretching and flexibility exercises are included to improve the knee range of motion. 

 As you progress, your sessions will focus on how to return to the things you enjoy.  For example, if you love gardening or playing golf, your sessions can focus on teaching you safe and proper ways to perform those activities in a way that minimizes stress on your knees, helping you better control the pain. In addition to sessions in the clinic, you will also be provided with an easy to follow Home Exercise Program (HEP) to help maintain the gains you make in therapy.

 If knee pain from OA is slowing you down, talk with your physical therapist and your doctor about the benefits of physical therapy to manage your knee pain so you get back to the things you enjoy and have some fun in the sun.