Apraxia is a poorly understood neurological condition. People who have it find it difficult or impossible to make certain motor movements, even though their muscles are normal. Milder forms of apraxia are known as dyspraxia.

Apraxia can occur in a number of different forms. One form is orofacial apraxia. People with orofacial apraxia are unable to voluntarily perform certain movements involving facial muscles. For instance, they may not be able to lick their lips or wink. Another form of apraxia affects a person’s ability to intentionally move arms and legs.

With apraxia of speech a person finds it difficult or impossible to move his or her mouth and tongue to speak. This happens, even though the person has the desire to speak and the mouth and tongue muscles are physically able to form words.

There are two forms of apraxia of speech — acquired apraxia and developmental apraxia. Acquired apraxia can occur in people of all ages. Typically, though, it is found in adults. This condition causes people to lose the speech-making abilities they once possessed.

Developmental apraxia of speech is also known as childhood apraxia of speech. This condition is present from birth, and it affects a child’s ability to form sounds and words. Children with speech apraxia often have far greater abilities to understand speech than to express themselves with spoken words.

The majority of children with developmental apraxia will experience significant improvement, if not complete recovery, with the correct treatment.

Apraxia is sometimes confused with aphasia, another communication disorder. That confusion can be complicated by the fact that the two conditions can occur together.

People with apraxia and aphasia might both have difficulty expressing themselves with words. There are, though, distinct differences between the two. Aphasia describes a problem in a person’s ability to understand or use words in and of themselves. This may make it hard for someone with the condition to speak, read, or write. But apraxia does not describe a problem with language comprehension. Apraxia refers to the difficulty someone has initiating and performing the movements needed to make speech. This difficulty arises despite the fact that there is no weakness in the necessary muscles.

There are a variety of speech-related symptoms that can be associated with apraxia, including:

• Difficulty stringing syllables together in the appropriate order to make words, or inability to do so
• Minimal babbling during infancy
• Difficulty saying long or complex words
• Repeated attempts at pronunciation of words
• Speech inconsistencies, such as being able to say a sound or word properly at certain times but not others
• Incorrect inflections or stresses on certain sounds or words
• Excessive use of nonverbal forms of communication
• Distorting of vowel sounds
• Omitting consonants at the beginnings and ends of words
• Seeming to grope or struggle to make words

Childhood apraxia of speech rarely occurs alone. It is often accompanied by other language or cognitive deficits, which may cause:

• Limited vocabulary
• Grammatical problems
• Problems with coordination and fine motor skills
• Difficulties chewing and swallowing
• Clumsiness

Acquired apraxia results from brain damage to those areas of the brain that control the ability to speak. Conditions that may produce acquired apraxia include head trauma, stroke, or a brain tumor.

Experts do not yet understand what causes childhood apraxia of speech. Some scientists believe that it results from signaling problems between the brain and the muscles used for speaking.

Ongoing research is focusing on whether brain abnormalities that cause apraxia of speech can be identified. Other research is looking for genetic causes of apraxia. Some studies are trying to determine exactly which parts of the brain are linked to the condition.

In some cases of acquired apraxia, the condition resolves spontaneously. This is not the case with developmental apraxia of speech, which does not go away without treatment.

There are various treatment approaches used for apraxia. How effective they are can vary from person to person. For the best results, apraxia treatment must be developed to meet a given individual’s needs. Most children with apraxia of speech benefit from meeting one on one with a speech-language pathologist three to five times a week. They may also need to work with their parents or guardians to practice the skills they are developing.

Therapy for childhood apraxia of speech aims to improve speech coordination. Exercises may include:

• Repeatedly practicing the formation and pronunciation of sounds and words
• Practicing stringing together sounds to make speech
• Working with rhythms or melodies
• Using multisensory approaches, such as watching in a mirror while trying to form words or touching the face while talking

Many therapists believe that sign language is beneficial for children who have difficulty being understood. They often recommend that children attempt to say the words they are signing to practice making the necessary movements with their mouths.

People with more extreme cases of acquired apraxia may also benefit from sign language. Or they may use assistive electronic devices, including computers that can be used to produce words and sentences.

Very few studies have been done to determine the relative effectiveness of various treatment approaches for childhood apraxia of speech. This may be due, in part, to ongoing debate among experts as to which symptoms and characteristics merit a diagnosis of apraxia.

The muscles in your lips, tongue, vocal cords, and diaphragm work together to help you speak clearly. With dysarthria, the part of your brain that controls them doesn’t work well and it’s hard for you to move those muscles the right way. Other people may not be able to understand you very well.

Some people with dysarthria have only minor speech problems. Others have a lot of trouble getting their words out. A speech-language therapist can help.

Dysarthria can make your speech:

• Flat
• Higher or lower pitched than usual
• Jerky
• Mumbled
• Slow or fast
• Slurred
• Soft, like a whisper
• Strained

It also can change the quality of your voice. You might sound hoarse or stuffed up, as if you have a cold.

Because dysarthria can make it harder to move your lips, tongue, and jaw, it can also make it harder for you to chew and swallow. Trouble swallowing can cause you to drool.

Conditions that cause this speech problem include:

• Amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s disease
• Brain injury
• Brain tumors
• Cerebral palsy
• Huntington’s disease
• Multiple sclerosis
• Parkinson’s disease
• Stroke

If you have trouble speaking, you should see a speech-language pathologist (SLP). She’ll ask about any diseases you have that could affect your speech.

• Stick out your tongue
• Make different sounds
• Read a few sentences
• Count numbers
• Sing
• Blow out a candle

Speech-language therapy is the only treatment for dysarthria. How much your speech may improve depends on the condition that caused it.

Your therapist will teach you:

• Exercises to strengthen the muscles of your mouth and jaw
• Ways to speak more clearly, such as talking more slowly or pausing to catch your breath
• How to control your breath to make your voice louder
• How to use devices like an amplifier to improve the sound of your voice

Your therapist also will give you tips to help you communicate, such as:

• Carry a notebook or smartphone with you. If someone doesn’t understand you, write or type what you want to say.
• Make sure you have the other person’s attention.
• Speak slowly.
• Talk face to face if you can. The other person will be able to understand you better if they can see your mouth move.
• Try not to talk in noisy places, like at a restaurant or party. Turn down music or the TV before you speak, or go outside.
• Use facial expressions or hand gestures to get your point across.
• Use short phrases and words that are easier for you to say.

Alopecia areata is a type of hair loss that occurs when your immune system mistakenly attacks hair follicles, which is where hair growth begins. The damage to the follicle is usually not permanent. Experts do not know why the immune system attacks the follicles. Alopecia areata is most common in people younger than 20, but children and adults of any age may be affected. Women and men are affected equally.

Alopecia areata usually begins when clumps of hair fall out, resulting in totally smooth, round hairless patches on the scalp or other areas of the body. In some cases the hair may become thinner without noticeable patches of baldness, or it may grow and break off, leaving short stubs (called “exclamation point” hair). In rare cases, complete loss of scalp hair and body hair occurs. The hair loss often comes and goes-hair will grow back over several months in one area but will fall out in another area.

When alopecia areata results in patches of hair loss, the hair usually grows back in a few months. Although the new hair is usually the same color and texture as the rest of the hair, it sometimes is fine and white.

About 10% of people with this condition may never regrow hair. You are more likely to have permanent hair loss if you:

• Have a family history of the condition.
• Have the condition at a young age (before puberty) or for longer than 1 year.
• Have another autoimmune disease.
• Are prone to allergies (atopy).
• Have extensive hair loss.
• Have abnormal color, shape, texture, or thickness of the fingernails or toenails.

Because hair is an important part of appearance, hair loss can result in feeling unattractive.

In some people with alopecia areata, the fingernails and toenails become pitted-they look as if a pin had made many tiny dents in them. They may also look like sandpaper.

Alopecia areata cannot be “cured” but it can be treated. Most people who have one episode will have more episodes of hair loss.

Because hair usually grows back within a year, you may decide not to treat alopecia areata.

If you choose not to treat the condition and wait for your hair to grow back, you may wish to:

• Wear hairpieces. Hairpieces are made from human or synthetic hair that is implanted into a nylon netting. Hairpieces may be attached to the scalp with glue, metal clips, or tape. But hair weaving, which involves sewing or braiding pieces of longer hair into existing hair, is not recommended because it may cause permanent hair loss.
• Use certain hair care products and styling techniques. Hair care products or perms may make hair appear thicker. Dyes may be used to color the scalp. But continual use of perms or dyes may result in more hair loss.

The most common treatment for patchy hair loss is many injections of corticosteroids into the scalp or skin, about 1 cm (0.4 in.) apart, every 4 to 6 weeks.

Children and some adults may be treated with topical corticosteroids that are applied to the affected skin.

Minoxidil (Rogaine) may be used along with topical corticosteroids.

Anthralin is an ointment that may help hair grow again. It looks and feels like tar, and it can irritate and stain the skin. So anthralin is applied to bare patches on the scalp only for a short time and then is washed off. It may take 2 months or more for new hair to grow.

Contact immunotherapy triggers an allergic reaction on the scalp that may help hair to grow. A medicine is “painted” on the scalp once a week. This irritates the skin and makes it red and scaly. Hair growth may appear within 3 months of beginning treatment. Side effects of contact immunotherapy include a severe rash (contact dermatitis) and swollen lymph nodes, especially in the neck.

Alopecia areata does not affect you as another condition might: it is not painful, it does not make you feel sick, and it does not result in serious health problems. You cannot spread it to other people, and it should not interfere with school, work, or recreation.

But if hair loss is making you feel unattractive, it is important to talk to someone about it. A counselor can help, as can talking to other people with the same condition.

Urticaria, also known as hives, is an outbreak of swollen, pale red bumps or plaques (wheals) on the skin that appear suddenly  either as a result of the body’s reaction to certain allergens, or for unknown reasons.

Hives usually cause itching, but may also burn or sting. They can appear anywhere on the body, including the face, lips, tongue, throat, or ears. Hives vary in size (from a pencil eraser to a dinner plate), and may join together to form larger areas known as plaques. They can last for hours, or up to one day before fading.

Angioedema is similar to hives, but the swelling occurs beneath the skin instead of on the surface. Angioedema is characterized by deep swelling around the eyes and lips and sometimes of the genitals, hands, and feet. It generally lasts longer than hives, but the swelling usually goes away in less than 24 hours.

Rarely, angioedema of the throat, tongue, or lungs can block the airways, causing difficulty breathing. This may become life threatening.

Symptoms:

If hives or angioedema occur with any of the following symptoms, contact your doctor right away:

• Dizziness
• Wheezing
• Difficulty breathing
• Tightness in the chest
• Swelling of the tongue, lips, or face

Allergic hives and angioedema form when, in response to histamine, bloodplasma leaks out of small blood vessels in the skin. Histamine is a chemical released from specialized cells along the skin’s blood vessels.

Allergic reactions, chemicals in certain foods, insect stings, sunlight exposure, or medications can all cause histamine release. It’s often impossible to find out exactly why hives have formed.

There are several different types of hives, including:

Acute urticaria: Hives lasting less than six weeks. The most common causes are certain foods, medications, or infections. Insect bites and internal disease may also be responsible.

The most common foods that cause hives are nuts, chocolate, fish, tomatoes, eggs, fresh berries, and milk. Fresh foods cause hives more often than cooked foods. Certain food additives and preservatives may also be to blame.

Drugs that can cause hives and angioedema include aspirin and other nonsteroidal anti-inflammatory medications such as ibuprofen, high blood pressure drugs (ACE inhibitors), or painkillers such as codeine.

Chronic urticaria and angioedema: Hives lasting more than six weeks. The cause of this type of hives is usually more difficult to identify than those causing acute urticaria. For most people with chronic urticaria, the cause is impossible to determine. In some cases, though, the cause may be thyroiddisease, hepatitis, infection, or cancer.

Chronic urticaria and angioedema can affect other internal organs such as the lungs, muscles, and gastrointestinal tract. Symptoms include muscle soreness, shortness of breath, vomiting, and diarrhea.

Physical urticaria: Hives caused by direct physical stimulation of the skin — for example, cold, heat, sun exposure, vibration, pressure, sweating, and exercise. The hives usually occur right where the skin was stimulated and rarely appear elsewhere. Most of the hives appear within one hour after exposure.

Dermatographism: This is a common form of physical urticaria where hives form after firmly stroking or scratching the skin. These hives can also occur along with other forms of urticaria.

Your doctor will need to ask many questions in an attempt to find the possible cause of hives or angiodema. Since there are no specific tests for hives or the associated swelling of angioedema — testing will depend on your medical history and a thorough exam by your primary care doctor or dermatologist.

Skin tests may be performed to determine the substance to which you are allergic. Routine blood tests are done to determine if a system-wide illness is present.

Hypertrichosis, also known as werewolf syndrome, is a condition characterized by excessive hair growth anywhere on a person’s body. It can affect both women and men, but it’s extremely rare. The abnormal hair growth may cover the face and body or occur in small patches. Hypertrichosis can appear at birth or develop over time.

Types of hypertrichosis

What Are Brain Disorders?

What Are the Different Types of Brain Disorders?

What Are the Risk Factors for Brain Disorders?

How Are Brain Disorders Diagnosed?

What is a corn? What is a callus?

Corns and calluses are hard, thickened areas of skin that form as a consequence of rubbing, friction or pressure on the skin.

Corns and calluses form on the feet and can make walking painful.

Although corns and calluses are often talked about together, they are separate conditions.

Corns generally occur on the tops and sides of the toes. A hard corn is a small patch of thickened, dead skin with a small plug of skin in the centre. A soft corn has a much thinner surface, appears whitish and rubbery, and usually occurs between the toes. Seed corns are clusters of tiny corns that can be very tender if they are on a weight-bearing part of the foot. Seed corns tend to occur on the bottom of the feet, and some doctors believe this condition is caused by blocked sweat ducts.

Calluses are hard and rough-feeling areas of skin that can develop on hands, feet or anywhere there is repeated friction – even on a violinist’s chin. Like corns, calluses have several variants. The common callus usually occurs when there has been a lot of rubbing against the hands or feet. A plantar callus is found on the bottom of the foot.

What causes corns and calluses?

Some corns and calluses on the feet develop from an improper walking motion, but most are caused by ill-fitting shoes. High-heeled shoes are the worst offenders. They put pressure on the toes and make women four times as likely as men to have foot problems. Other risk factors for developing a corn or callus include foot deformities and wearing shoes or sandals without socks, which leads to friction on the feet.

Rubbing or pressure can cause either soft corns or plantar calluses. If you or yourchild develops a callus that has no clear source of pressure, have it looked at by a doctor or a podiatrist, since it could be a wart or be caused by a foreign body – such as a splinter – trapped under the skin. Feet spend most of their time in a closed, moist environment, which is ideal for breeding fungal and bacterial infections. Staph (bacterial) infections can start when bacteria enter corns through breaks in the skin and cause the infected skin to discharge fluid or pus.

What are the symptoms of corns and calluses?

• A callus is a patch of compact, dead skin anywhere on the body that is subject to friction. There are different common names given to various types of calluses.
• A hard corn is a compact patch of hard skin with a dense core, located on top of a toe or the outside of the little toe.
• A soft corn is a reddened, tender area of skin, has a thin, smooth centre and is found between toes.
• A seed corn is a plug-like circle of dead skin, often painful, on the heel or ball of the foot.
• A plantar callus is a callus on the bottom – or plantar – surface of the foot.

How do I know if I have a corn or a wart?

To find out whether a hard patch of skin is a corn or a wart, your doctor will examine the affected area. Warts are viral and often have black dots present in the affected skin. They also require specific treatment. Most calluses are corrected by a variety of measures, including a change in shoes, trimming of the calluses and sometimes surgery.

What are the treatments for corns and calluses?

Most corns and calluses gradually disappear when the friction or pressure stops, although your doctor may shave the top of a callus to reduce the thickness. Properly positioned moleskin pads can help relieve pressure on a corn. There are also special corn and callus removal liquids and plasters, usually containingsalicylic acid, but these are not suitable for everyone.

Oral antibiotics generally clear up infected corns, but pus may have to be drained through a small incision.

Moisturising creams may help soften the skin and remove cracked calluses. Apply the moisturising cream to the callus, and cover the area for 30-60 minutes with a plastic bag or a sock – but only if instructed to do so by your doctor or podiatrist.

Then gently rub off as much of the callus as you can with a coarse towel or soft brush. Using a pumice stone first to rub off the dead skin from a callus after a bath or shower and then applying moisturising cream can also be effective.

There are also stronger creams containing urea that might be more effective, but do not use these unless recommended by your doctor or podiatrist. Do not usehydrocortisone creams, which only help with rashes and itching and are not needed for calluses. Moisturising your skin incorrectly can aggravate a fungal condition and should be avoided – especially moisturising between the toes.

You may consider surgery to remove a plantar callus, but there are no guarantees that the callus will not come back. A conservative approach is best initially. Keep your feet dry and friction-free. Wear properly fitted shoes and cotton socks, rather than wool or synthetic fibres that might irritate the skin.

If a podiatrist (a foot specialist) or orthopaedic specialist (a bone and jointspecialist) thinks your corn or callus is caused by abnormal foot structure, your walking motion or hip rotation, orthopaedic shoe inserts or surgery to correct foot deformities may help correct the problem.

How can I prevent corns and calluses?

• To avoid corns and calluses on the feet, always have both feet professionally measured when buying shoes, and only wear properly fitting shoes.
• Make sure that both shoe width and length are correct – for each foot – since your feet may be slightly different sizes. Allow up to 1.3cm (half an inch) between your longest toe and the front of the shoe. If you can’t wiggle your toes in your shoes, they are too tight.
• Avoid shoes with sharply pointed toes and high heels. Women who prefer such shoes, or who are expected to wear them at work, can take some of the pressure off their feet by walking to their destination in well-fitted flat shoes, and then changing them. Try to decrease heel height as much as possible.
• Have your shoes repaired regularly – or replace them. Worn soles give little protection from the shock of walking on hard surfaces, and worn linings can chafe your skin and harbour bacteria.
• Worn heels increase any uneven pressure on your heel bone. If the soles or heels of your shoes tend to wear unevenly, talk to you doctor about corrective shoes or insoles.
• If you have hammertoes – toes that are buckled under – make sure that the shape of your shoes offers plenty of room to accommodate the buckled toes.

An Achilles tendon injury can happen to anyone, whether you’re an athlete or just going about your everyday life.

The Achilles tendon is the largest tendon in your body. It stretches from the bones of your heel to your calf muscles. You can feel it — a springy band of tissue at the back of your ankle and above your heel. It lets you point your toes toward the floor and raise up on your tiptoes.

It’s common for this tendon to get injured. It can be mild or moderate and feel like a burning pain or stiffness in that part of your leg. If the pain is severe, your Achilles tendon may be partly torn or completely ruptured.

Achilles tendon injuries are common in people who do things where they quickly speed up, slow down, or pivot, such as:

• Running
• Gymnastics
• Dance
• Football
• Baseball
• Softball
• Basketball
• Tennis
• Volleyball

These injuries tend to happen when you start moving suddenly as you push off and lift your foot rather than when you land. For instance, a sprinter might get one at the start of a race as he surges off the starting block. The abrupt action can be too much for the tendon to handle. Men over 30 are particularly prone to Achilles tendon injuries.

These things also can make you more likely to have this kind of injury:

• You wear high heels, which can stress the tendon.
• You have “flat feet,” also called fallen arches. This means that when you take a step, the impact causes the arch of your foot to collapse, stretching the muscles and tendons.
• Your leg muscles or tendons are too tight.
• You take medicines called glucocorticoids or antibiotics called fluoroquinolones.
• 

The most obvious sign is pain above your heel, especially when you stretch your ankle or stand on your toes. It may be mild and get better or worse over time. If the tendon ruptures, the pain is instant and severe. The area may also feel tender, swollen, and stiff.

If your Achilles tendon tears, you may hear a snapping or popping noise when it happens. You could have bruising and swelling, too. You also may have trouble pointing your toes and pushing off your toes when you take a step.

Minor to moderate Achilles tendon injuries should heal on their own. To speed the process, you can:

• Rest your leg. Avoid putting weight on your leg as best you can. You may need crutches.
• Ice it. Ice your injury for 20 to 30 minutes every 3 to 4 hours to reduce pain and swelling. Continue this for 2 or 3 days, or until the pain is gone.
• Compress your leg. Use an elastic bandage around the lower leg and ankle to keep down swelling.
• Raise (elevate) your leg. Prop your leg up on a pillow when you’re sitting or lying down.
• Take anti-inflammatory painkillers. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen will help with pain and swelling. Follow the instructions on the label to help prevent side effects, such as bleeding and ulcers. Take them with food. Check with your doctor first if you have any allergies, medical problems or take any other medication. If you need them for longer than 7 to 10 days, call your doctor.
• Use a heel lift. Your doctor may recommend that you wear an insert in your shoe while you recover. It will help protect your Achilles tendon from further stretching.
• Practice stretching and strengthening exercises as recommended by your doctor, physical therapist, or other health care provider.

 When Will I Feel Better?

It may take months, but it depends on how serious your injury is. Different conditions heal at different rates.

You can still be active while your injury heals. Ask your doctor what’s OK to do. But don’t rush things. Don’t try to return to your old level of physical activity until:

• You can move your leg as easily and freely as your uninjured leg.
• Your leg feels as strong as your uninjured leg.
• You don’t have any pain in your leg when you walk, jog, sprint, or jump.

Here are some things you can try:

• Cut down on uphill running.
• Wear shoes with good support that fit well.
• Stop exercising if you feel pain or tightness in the back of your calf or heel.