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Apraxia: Overview and More

Apraxia is a neurological disorder that affects the brain pathways involved in control, coordination, and planning of everyday movements and gestures. Apraxia is a neurological disorder characterized by an inability to perform everyday or highly trained movements, despite having normal muscle tone and strength. This is due to problems with cognition and motor planning and is often caused by a

  • Posted on 20th Apr, 2022 13:55 PM
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Apraxia is a neurological disorder characterized by an inability to perform everyday or highly trained movements, despite having normal muscle tone and strength. This is due to problems with cognition and motor planning and is often caused by a brain disorder or damage.

This article will describe different types of apraxia, symptoms, how it is diagnosed, and treatment options.

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Types of Apraxia

There are several different forms of apraxia that cause difficulty with everyday tasks and movements. However, it is common for more than one type of apraxia to be present at the same time. Types of apraxia include:

  • Ideomotor: Inability to perform gestures upon verbal command or impairment in executing the use of a tool (not being able to use a spoon despite being able to describe how to use it)
  • Ideational: Inability to conceptualize how to perform tasks with multiple, sequential movements (eating, bathing, and dressing)
  • Limb-kinetic: Inability to make precise and coordinated finger and hand movements (buttoning a shirt or rotating a coin in the fingers)
  • Buccofacial/orofacial: Inability to carry out facial movements when instructed (licking lips, whistling, coughing, or winking)
  • Verbal apraxia: Difficulty coordinating mouth movements to produce speech
  • Constructional: Inability to copy or draw objects or symbols
  • Oculomotor: Difficulty moving the eyes when instructed

Apraxia Symptoms

Apraxia causes difficulty performing everyday tasks and activities of daily living despite no damage to muscle tone or strength. People with apraxia will often struggle with:

  • Dressing
  • Brushing teeth
  • Brushing hair
  • Bathing
  • Toileting
  • Cooking
  • Cleaning
  • Housework
  • Writing
  • Grasping tools 

Verbal apraxia (also called apraxia of speech) uniquely affects the planning and sequencing of motor movements used to produce speech, which can cause difficulty pronouncing words, distorted speech, and speech errors.

Causes

Apraxia is caused by damage to specific areas of the brain involved in motor planning and movement coordination. These areas include:

  • The left premotor cortex within the left frontal lobe (movement planning)
  • The left temporal lobe (memory retrieval of performing movements)
  • The left parietal cortex (spatial-temporal information for coordinating and planning movements)

Apraxia may also result from damage to the corpus callosum, the bundle of fibers that connect the left hemisphere to the right hemisphere of the brain.

Damage to these brain areas can occur from:

  • Stroke (loss of blood flow to part of the brain)
  • Dementia (group of conditions causing loss of memory, language skills, problem-solving skills, and the ability to think)
  • Parkinson’s disease (progressive neurological disorder affecting movement)
  • Brain tumor (a growth of abnormal cells in the brain)
  • Traumatic brain injury (TBI, injury affecting how the brain works)
  • Hydrocephalus (buildup of fluid in the brain)
  • Corticobasal syndrome (rare neurological disorder causing the brain to shrink and nerves to die over time)
  • Progressive supranuclear palsy (rare brain disorder that impacts balance and movement)

Apraxia results from damage to areas in the left side of the brain and occur in approximately one-third of patients who experience a stroke in the left hemisphere of the brain.

Diagnosis

Apraxia can be diagnosed by your healthcare provider. Your practitioner will test your muscle strength, range of motion, coordination, and cognition.  

The Test of Upper Limb Apraxia (TULIA) can also be used to help determine whether apraxia is present. This test takes about 20 minutes to complete. During the test, a healthcare professional will demonstrate movements and then instruct you to reproduce the movements as precisely as possible. Some movements used in the TULIA include:

  • Putting your index finger on top of your nose
  • Placing your hand flat on top of your head
  • Wiping dust from your shoulder
  • Saluting like a soldier
  • Making the hitchhiking gesture
  • Combing your hair
  • Brushing your teeth
  • Using scissors
  • Scratching your head
  • Blowing a kiss
  • Waving goodbye

The physical exam is scored between 0 (no movement) and 5 (normal movement). Lower scores on the test indicate greater severity of apraxia symptoms.

To help determine the underlying cause of apraxia, other tests may be performed. These include:

  • A magnetic resonance imaging (MRI) or computed tomography (CT) scan of the brain
  • An electroencephalogram (EEG) to rule out epilepsy
  • A lumbar puncture (also called a spinal tap, inserting a needle between two vertebrae to remove a sample of cerebrospinal fluid) to check for a neurological infection

Treatment

Rehabilitation is the main treatment for apraxia, which can consist of:

  • Physical therapy to increase gross motor strength, coordination, and motor control
  • Occupational therapy to improve fine motor movement, coordination, motor planning, motor control, cognition, and training in activities of daily living
  • Speech therapy to improve oral motor control and pronunciation of speech sounds

Transcranial direct current stimulation to areas with the left side of the brain may be beneficial to improve motor planning and control to perform tasks and gestures. However, research in this field is ongoing.

Prognosis

Apraxia is a difficult condition to treat as it often results from brain damage from permanent injury or neurodegenerative conditions that worsen over time. Many people with apraxia require assistance to help them complete daily tasks such as bathing, dressing, and cooking. If apraxia results from a recent stroke or brain injury, early, intensive rehabilitation is crucial for maximizing successful outcomes to regain prior functions.

Summary 

Apraxia is a neurological disorder characterized by an inability to perform everyday movements, despite having normal muscle tone and strength. This is due to problems with cognition and motor planning, which can interfere with daily living. Different forms of ataxia include ideomotor, ideational, limb-kinetic, buccofacial/orofacial, verbal, constructional, and oculomotor.

Apraxia results from damage to regions within the left side of the brain, especially from stroke, traumatic brain injury, Parkinson's disease, or dementia. Rehabilitation including physical, occupational, and speech therapy can be used to help regain function.

A Word From Verywell

Apraxia can be challenging to deal with due to a loss in movements required for everyday activities. Whether apraxia occurs suddenly or gradually over time, you may require ongoing assistance to help you complete your daily tasks. Early, intensive rehabilitation may be able to help restore lost function in certain instances.

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