*The tag in that shirt
*The seem on those socks
*The wind that is too much to handle
*Cottage cheese feels unpleasant in your mouth...gag!
We just find ways to adapt.
A child with a neurological dysfunction (or two) like Apraxia and Sensory Processing Disorder can't adapt quite as easily. Why not?
Well, let's first review the definition of apraxia. If you look in the dictionary, apraxia is the inability to perform particular actions as a result of brain damage. When applied to speech, it obviously affects a person's ability to communicate "normally." I remember when our Kelly was first diagnosed, the insurance company did not want to approve therapy because the "result of brain damage" was not proven as a result of an accident. Her occupational therapist said that if she were cognitive (and big) enough to ride a motorcycle and crash it, that's the comparable brain damage.
A person challenged with apraxia has trouble with language and communication. As a mom, I've observed that my daughter has trouble with both "ends" of communication: the receptive as well as the expressive, especially when her senses are on overload. That's the Sensory Processing Disorder - when the senses receive information incorrectly. We are kept "normal" by so much more than the five senses we learned about in elementary school.
Our vestibular system keeps us balanced. A person with a weak vestibular system (regulated by the inner ear) may seem clumsy, off balance, awkward, and may not be able to do activities that require coordinating the movement of both legs, feet, hands, or arms such as playing soccer or the piano. To help Kelly regulate her vestibular system, she spins, swings, swims, jumps (on a trampoline,) and horseback rides. Others may try karate, kayaking, dancing or gymnastics.
Proprioreception is our sense of where we are in this space and what our body needs to do to adjust. An example: walking from one room that has carpeted flooring to another which is hard wood. The typical person just keeps going as the body adjusts itself from one flooring to the next. The person with SPD cannot adjust as easily. She has to think about how to make the move from one floor to the next. When she was little, Kelly would sit down, scootch to the next "floor type" then stand to continue walking. Yes, even when the floors were level! Lots of practice and exposure later, she can easily adjust her step or knows to take it slowly (and perhaps hold onto something) when she's unfamiliar with the terrain.
These two systems, the vestibular and proprioreceptive, as you may guess, work together to help a person adjust to their environment. It takes both systems to "plan" a movement such as eating with a utensil, catching a football, or picking up a pencil and writing, or communicate. And this is just the beginning of sensory processing disorder. These children can be challenged by oral, auditory, touch, and visual defensiveness as well. It's a tough world out there for anyone to try to express all these challenges when their ability to communicate is also challenged. Which brings us back to apraxia and the types of communication.
Receptive communication is what you hear and process as incoming information, but it does not stop there. It is also the visuals all around you, the "feels" all around you, what is going on around you and the one "sending" you the information, what you filter in and what you block out.
Expressive communication is what you want or need to share with others. For the typical person, it may begin with speech, but it also includes emotions and understanding and the physical ability to make the sounds. Many children with apraxia do learn to speak or at least make appropriate sounds, but expressive communication most often needs to include additional means for someone with apraxia and SPD. Since Kelly's speech is minimal, we--Kelly, her teachers, and her family--use three techniques to help her get through her day: pictures, sign language, and gestures.
Pictures - of everything! - help when a child cannot come up with the word or words. We use them for schedules, in specific and stationary settings (the classroom, the kitchen) and when introducing a series of events such as going to the dentist before going to a baseball game. Sign language and gestures work well because you don't have to carry anything around. Unfortunately the apraxia challenges that expressive communication, too. We find that simple, functional signs work better than "conversational" signing. For instance, if Kelly wants to go to the zoo or for a swim, she signs "zoo" or "swim," not "Mom, can we go swimming today?" It's too difficult to put all that together. But rest assured, even a special needs person can learn and use the magic words!
So how do we, as parents, deal with this challenge? We listen to parents who have gone ahead of us, to those professionals who love and care for our children, we read and read and try and try again, and we pray a lot!
Please add your comments or ask questions. I may not have all the answers, but I'll definitely share my experience on the matter.
