The new Dr Who and a view of dyspraxia
23 October 2018
Opinion: Dyspraxia is entering public conscience via a character in Dr Who. Liz FairGray (Science) adds depth to the TV portrayal of this complex disorder.
Dyspraxia is a term which seems to have made its way into the collective vocabulary of society in general, much like the terms “dyslexia” and “autism” which were once used only by academics or medical professionals.
It seems that these words now trip off the tongue; pronounced easily, applied frequently and used to describe anybody who seems to be doing things in a way which is not typical of people in general. However, do most of us actually know what these words mean? In particular, for this article, do people know what is meant by the term “dyspraxia”?
Is it possible that the general population will develop their concept of dyspraxia to be that which is represented by the friend of the latest Dr Who in her latest escapades? Sometimes it seems that people derive their concepts of autism from the character in the movie Rain Man and this current Dr Who may parallel this simplistic perception of a complex disorder.
So, let’s investigate this term a little and try to add some layers of depth to the description of dyspraxia.
Dyspraxia is a defined as a developmental coordination disorder. Despite the word “developmental”, dyspraxia is recognised by The World Health Organisation as a lifelong condition in which the symptoms vary, affected by age, treatment and environment. In this context “developmental” refers to the fact that a person is born with the tendency toward dyspraxia. It is not acquired as a consequence of stroke, Parkinson’s disease, cerebral palsy etc., even though people with these conditions may show similar coordination difficulties. Dyspraxia is a disorder which affects the coordination of sequenced muscle movements which should occur in a smooth orderly manner. Coordinated sequenced muscle movements are essential to all aspects of life and the more complex the task, the greater the number of movements which need to be sequenced.
Consider the daily tasks which require no conscious thought on our part – the act of walking followed by sitting, the action of using the muscles of the mouth and nose when chewing and swallowing food while coordinating this with moving these same muscles to breathe at the same time.
Now consider how much more challenging life would be if we had to consciously plan the muscle movements to accomplish these tasks. This is what happens when people have dyspraxia. Dyspraxia can occur within any muscle group of the body. The greater the number of muscles involved the greater the severity of the challenges facing the person with dyspraxia.
How do muscles ”know” what to do?”
When we plan to move parts of our body or use our face muscles to speak, how do muscles know which direction to move, how much pressure to exert and how rapidly they should move? The muscles “know” because a message is sent from the brain to the muscles.
When people have dyspraxia, the message to the muscles is disrupted.
The strength of the muscle is unaffected and there is no withering away of the muscle as may occur in a person who has had an injury.
The intellectual thought processes of the person are totally intact. (I know I need to lift my foot off the floor, then swing my body forward and replace my foot back on the ground).
The delivery of the message is disrupted as it travels between the brain and muscle. This is why people appear to be uncoordinated and clumsy.
What characterises 'Dyspraxia'?
Dyspraxia is characterised by a poorly coordinated muscle movements in different parts of the body. In practical terms, we may first notice children with delayed milestones for sitting, walking, running etc. They may fall over more frequently, “trip over their own feet”, bump into furniture etc., as they do not adjust their muscle movements to accommodate items in their environment. Difficulties with movements in large muscle groups can affect actions such as learning to ride a bike, playing sports where running, batting, throwing, catching all need to occur with precision and speed.
People with dyspraxia in these large muscle groups can improve their skill, but they require significantly more time and effort than most people, in order to achieve even basic proficiency. As adults, many people adjust and learn to compensate, taking care to plan a visual route or to carefully think, for example, “I will need to turn right at this corner”. Visual memory and sequencing of visual information may be more challenging.
Some people with dyspraxia have challenges moving smaller muscle groups. The small facial muscles involved in eating and speaking may be affected. Sometimes children can be very difficult to understand because the programming of the speech muscles is significantly impaired. Attempts to say specific sounds (for example: “Sh”) are incorrect, so listeners do not know what the child is trying to say. This type of dyspraxia (also called Apraxia of Speech) requires intense speech therapy; often for several years. Speech–language therapists specialise in working with children who have this disorder and are often successful in teaching the child to speak clearly, even if the speech is not 100 percent accurate.
So in summary, dyspraxia is a complex developmental coordination disorder in which the sequence of muscle movements is interrupted. The muscles themselves hold typical levels of strength and show no sign of wasting. Similarly the intellectual ability of the person is within the normal range and no damage to the brain is observed in a CT scan or MRI.
The characteristics of dyspraxia feature poorly coordinated movements; affecting either large muscle groups or small muscle groups. Effects include clumsy movement, lack of coordination and difficulties responding to visual information. Often a secondary difficulty such as Attention Deficit Disorder may occur within the same individual and in children with verbal dyspraxia, speech is very difficult to understand. Speech language therapy for these children and occupational therapy are both helpful as the individual is taught specific strategies to improve coordination.
Introducing Ryan, the character with dyspraxia in the new Dr Who, will undoubtedly bring a welcome and increased awareness of the condition to the general public. However, it must be remembered that, like the concept of autism we see in Rain Man, the fictional portrayal is simplistic and the facts of the condition are much more deeply layered and complex.
Liz Fairgray is a clinical educator in the Programme of Speech Sciences in the Faculty of Science. This article reflects the opinion of the author and not the views of the University of Auckland.
Used with permission from Newsroom, The new Dr Who and a view of dyspraxia published on 23 October 2018.