This article features the most common kinds of apraxia associated with occupational therapy, prognosis, and treatment.
Contents Hide
1 About Apraxia
2 Common Types of Apraxia
3 Other Types
4 Ideational Apraxia
5 Conceptual Apraxia
6 Ideomotor Apraxia
7 Constructional Apraxia
8 Dressing Apraxia
9 Prognosis
10 Treatment
11 Interventions
12 References [+]
About Apraxia
- Apraxia is a neurological disorder that is characterized by the loss of the ability to carry out skilled movements.
- There is usually no loss of motivation or physical ability to perform these movements.
- Dyspraxia is a mild form of apraxia. (the a- prefix means without, so apraxia is more severe than dyspraxia)
- Apraxia results from a dysfunction in the cerebral hemispheres of the brain in the parietal lobe.
- Apraxias can occur alone or in a combination together.[1]NIH. (2019). Apraxia Information Page. Retrieved from https://www.ninds.nih.gov/Disorders/All-Disorders/Apraxia-Information-Page
Common Types of Apraxia
- Anatomy descriptions of apraxia: buccofacial apraxia, orofacial apraxia, limb-kinetic apraxia, oculomotor, etc.
- Ideomotor apraxia
- Ideational apraxia
- Conceptual apraxia
- Constructional apraxia
- Verbal apraxia, Aphasia
Other Types
- Aphasia is a language disorder associated type of apraxia that results in the loss of ability to understand or express speech, caused by brain damage.
- “Both aphasia and apraxia are speech disorders, and both can result from brain injury most often to areas in the left side of the brain. However apraxia is different from aphasia in that it is not an impairment of linguistic capabilities but rather of the more motor aspects of speech production. People with aphasia who also have apraxia may be further limited in their ability to compensate for the speech impairment by using informative gestures.”[2]National Aphasia Association. (n.d.). Apraxia. Retrieved from https://www.aphasia.org/aphasia-resources/apraxia/
Ideational Apraxia
Memory Trick: idea (idea is in the word)
- Characterized by the loss of ability to conceptualize and plan a motor sequence action [sequencing].
- “The inability to order the set of elementary movements that makes a complex action into their correct sequence.”
- Difficulty with sequencing multi-step tasks.
- Example: omitting, adding, or transposing steps in the sequence of movements used in pantomiming eating soup with a spoon.
Conceptual Apraxia
Memory Trick: conceptualizing
Sometimes used synonymously with ideational apraxia. Conceptual apraxia is more specifically:
- The perception of an object’s intended purpose is lost.[3] Buxbaum LJ, Schwartz MF, Montgomery MW (1998). “Ideational apraxia and naturalistic action”. Cognitive Neuropsychology. 15 (6–8): 617–43. doi:10.1080/026432998381032. PMID 22448839.
- Using a tool incorrectly or not for its intended purpose.
- “What is this and what is it used for?”
- Examples: writing with scissors, or brushing teeth using a spoon.[4]Peigneux, P. (2010). Current Models and Assessment of Limb Apraxia. Encyclopedia of Behavioral Neuroscience.
Ideomotor Apraxia
Memory Trick: themotorin ideomotor dyspraxia; idea is in the word, but is spelled with an ‘o’, so pay more attention to the motor. Ideational apraxia (see above) is where you pay more attention to the ‘idea’ as it is spelled correctly with an ‘a’.
- Can conceptualize the action cognitively.
- Deficit of the execution of action upon request (verbal command) or imitation.
- Often can execute spontaneous actions such as gestures and one-step tasks, e.g., automatic actions.
- Examples: pretending to use a hammer, brushing one’s hair, waving goodbye.[5]Wheaton LA, Hallett M. Ideomotor apraxia: a review. J Neurol Sci. 2007 Sep 15;260(1-2):1-10. doi: 10.1016/j.jns.2007.04.014. Epub 2007 May 16. PMID: 17507030.
- OT can be effective to help regain functional control.
- One approach involves breaking down the task into separate components and teaching them individually until mastered.
- Requires repetition.[6]Sunderland, A.; Shinner, C. (Apr 2007). “Ideomotor apraxia and functional ability”. Cortex. 43 (3): 359–67. doi:10.1016/S0010-9452(08)70461-1. PMID 17533759. S2CID 4484338.
Constructional Apraxia
Memory Trick: construction paper
- Impairment of 2-dimensional and 3-dimensional tasks.
- Difficulty arranging, building, and drawing in 2D or 3D space.
- “Inability to reproduce or accurately construct a representation of a named or viewed visual stimulus despite adequate limb strength and physical and visual capacity.”[7]Pelak, V. (2020). Visual Cortical Disorders. Reference Module in Neuroscience and Biobehavioral Psychology
- Common after a right parietal stroke.[8]Russell C, Deidda C, Malhotra P, Crinion JT, Merola S, Husain M. A deficit of spatial remapping in constructional apraxia after right-hemisphere stroke. Brain. 2010 Apr;133(Pt 4):1239-51. doi:… Reference List
- Common in Alzheimer’s disease, Lewy Body Dementia, and other neurodegenerative dementing disorders.[9]Trojano, L., & Gainotti, G. (2016). Drawing disorders in Alzheimer’s disease and other forms of dementia. Journal of Alzheimer’s Disease, 53(1), 31-52.
- Often associated with general mental impairment.
- Performance varies even with the same individual as tasks that involve assembly and building are different than drawing tasks.[10]Hamsher, K. (1998). Intelligence and Aphasia. Acquired Aphasia: 3rd Edition
- Example: inability to accurately copy drawings, e.g., 3D cube in MoCA test.
- Difficulty with clock drawing, poor performance in MMSE
Dressing Apraxia
- Characterized by the difficulty with the automatic and spontaneous capacity for dressing (donning and doffing clothes).[11]Haughey, F., Morgan, J. M., & Stapleton, T. (2012). A case of dressing apraxia? A case study. International Journal of Therapy and Rehabilitation, 19(12), 704-710.
- Often associated with right parietal lobe lesions, e.g., CVA.[12]Ceccaldi M, Poncet M, Gambarelli D, Guinot H, Bille J. Progressive severity of left unilateral apraxia in 2 cases of Alzheimer’s disease. Rev Neurol. 1995;151: 240-246.[13]Rapcsak S Z, Ochipa C, Anderson K C, Poizner H. Progressive ideomotor apraxia: evidence for a selective impairment of the action production system. Brain Cogn. 1995;27:213-236.[14]Hier DB, Mondlock J, Caplan LR. Behavioral abnormalities after right hemi- sphere stroke. Neurology. 1983;33:337-344.
- Associated with difficulty in visual matching (perceptual), spatial abilities, and cancellation tasks for visual inattention.[15]Walker, M. F., & Lincoln, N. B. (1991). Factors influencing dressing performance after stroke. Journal of Neurology, Neurosurgery & Psychiatry, 54(8), 699-701.
- Examples: putting on a t-shirt backward – “Is this the front or the back?”
Prognosis
The prognosis varies depending on the underlying cause, severity, and other factors. Improvement arises from significant to mild if any.
Treatment
- Treating the underlying condition.
- Occupational therapy
- Speech therapy
- Physical therapy
Interventions
Source[16]West, C., Bowen, A., Hesketh, A., & Vail, A. (2008). Interventions for motor apraxia following stroke. The Cochrane database of systematic reviews, 2008(1), CD004132.… Reference List
Strategy training in daily living activities: this technique teaches internal (for example, the patient is taught to verbalise and implement the task steps at the same time) or external (for example, when aids are used to overcome a functional barrier) compensatory strategies that enable a functional task to be completed. These strategies will not have been used prior to the stroke (Van Heugten 1998);
Sensory stimulation: stimulations including deep pressure, sharp and soft touch are applied to the patients’ limbs (Butler 1994);
Proprioceptive stimulation: the patient leans on and puts weight through their upper and lower limbs;
Cueing, verbal or physical prompts: given to enable each stage of the task to be completed;
Chaining (forward or backward): the task is broken down into its component parts. Using backward chaining the task is completed with facilitation from the therapist apart from the final component, which the patient carries out unaided. If successful next time further steps are introduced. Forward chaining is the reverse of backward chaining;
Normal movement approaches: the therapist facilitates the body through normal movement patterns.
References
| ↑1 | NIH. (2019). Apraxia Information Page. Retrieved from https://www.ninds.nih.gov/Disorders/All-Disorders/Apraxia-Information-Page |
|---|---|
| ↑2 | National Aphasia Association. (n.d.). Apraxia. Retrieved from https://www.aphasia.org/aphasia-resources/apraxia/ |
| ↑3 | Buxbaum LJ, Schwartz MF, Montgomery MW (1998). “Ideational apraxia and naturalistic action”. Cognitive Neuropsychology. 15 (6–8): 617–43. doi:10.1080/026432998381032. PMID 22448839. |
| ↑4 | Peigneux, P. (2010). Current Models and Assessment of Limb Apraxia. Encyclopedia of Behavioral Neuroscience. |
| ↑5 | Wheaton LA, Hallett M. Ideomotor apraxia: a review. J Neurol Sci. 2007 Sep 15;260(1-2):1-10. doi: 10.1016/j.jns.2007.04.014. Epub 2007 May 16. PMID: 17507030. |
| ↑6 | Sunderland, A.; Shinner, C. (Apr 2007). “Ideomotor apraxia and functional ability”. Cortex. 43 (3): 359–67. doi:10.1016/S0010-9452(08)70461-1. PMID 17533759. S2CID 4484338. |
| ↑7 | Pelak, V. (2020). Visual Cortical Disorders. Reference Module in Neuroscience and Biobehavioral Psychology |
| ↑8 | Russell C, Deidda C, Malhotra P, Crinion JT, Merola S, Husain M. A deficit of spatial remapping in constructional apraxia after right-hemisphere stroke. Brain. 2010 Apr;133(Pt 4):1239-51. doi: 10.1093/brain/awq052. PMID: 20375139. |
| ↑9 | Trojano, L., & Gainotti, G. (2016). Drawing disorders in Alzheimer’s disease and other forms of dementia. Journal of Alzheimer’s Disease, 53(1), 31-52. |
| ↑10 | Hamsher, K. (1998). Intelligence and Aphasia. Acquired Aphasia: 3rd Edition |
| ↑11 | Haughey, F., Morgan, J. M., & Stapleton, T. (2012). A case of dressing apraxia? A case study. International Journal of Therapy and Rehabilitation, 19(12), 704-710. |
| ↑12 | Ceccaldi M, Poncet M, Gambarelli D, Guinot H, Bille J. Progressive severity of left unilateral apraxia in 2 cases of Alzheimer’s disease. Rev Neurol. 1995;151: 240-246. |
| ↑13 | Rapcsak S Z, Ochipa C, Anderson K C, Poizner H. Progressive ideomotor apraxia: evidence for a selective impairment of the action production system. Brain Cogn. 1995;27:213-236. |
| ↑14 | Hier DB, Mondlock J, Caplan LR. Behavioral abnormalities after right hemi- sphere stroke. Neurology. 1983;33:337-344. |
| ↑15 | Walker, M. F., & Lincoln, N. B. (1991). Factors influencing dressing performance after stroke. Journal of Neurology, Neurosurgery & Psychiatry, 54(8), 699-701. |
| ↑16 | West, C., Bowen, A., Hesketh, A., & Vail, A. (2008). Interventions for motor apraxia following stroke. The Cochrane database of systematic reviews, 2008(1), CD004132. https://doi.org/10.1002/14651858.CD004132.pub2 |
FAQs
What is the difference between ideomotor apraxia and ideational apraxia? ›
Ideational apraxia is due to parietal lesions, most often diffuse and degenerative. In ideomotor apraxia the concept or plan of movement is intact, but the individual motor engrams or programs are defective.
What is ideomotor vs constructional apraxia? ›2. Ideomotor apraxia, when the patient may know and remember the planned action but cannot execute it with either hand (e.g., cutting a piece of paper with scissors). 3. Conduction apraxia, when the patient shows a greater impairment when imitating movements than when pantomiming to command.
What are the three types of apraxia? ›Orienting apraxia: Difficulty in orienting one's body with reference to other objects. Mirror apraxia: A deficit in reaching to objects presented in a mirror. Lesion-specific apraxias: Callosal apraxia - Apraxia caused by damage to the anterior corpus callosum that usually affects the left limb.
What are examples of ideational apraxia? ›Ideational apraxia: Patients with ideational apraxia cannot perceive the purpose of a previously learned complex task and thus cannot plan or execute the required voluntary movements in the correct sequence. For example, they may put their shoes on before their socks.
What is an example of ideomotor apraxia? ›Ideomotor apraxia (IMA) is a disorder traditionally characterized by deficits in properly performing tool-use pantomimes (e.g., pretending to use a hammer) and communicative gestures (e.g., waving goodbye).
What is constructional apraxia? ›Constructional apraxia refers to the inability of patients to copy accurately drawings or three-dimensional constructions. It is a common disorder after right parietal stroke, often persisting after initial problems such as visuospatial neglect have resolved.
What type of apraxia is dressing apraxia? ›Dressing apraxia refers to inattention to the left side when dressing; it signifies a feature of the neglect syndrome rather than the loss of the ability to use tools. Typically, a right hemisphere lesion is implicated. It has no relationship to ideomotor apraxia.
How do you test for construction apraxia? ›Constructional disabilities are often tested by asking the patient to draw a 2D model or assemble an object. Some researchers feel that neuronal mechanisms involved in drawing and copying differ, thus they should be tested individually.
How do you assess constructional apraxia? ›Constructional apraxia is an inability to reproduce patterns or join component parts into a whole. This condition is assessed through observation of a patient completing activities such as drawing, copying, or building three-dimensional objects (Lezak, Howieson, & Loring, 2004).
What are the 2 main types of apraxia? ›People with buccofacial apraxia, or facial-oral apraxia, are unable to make movements with the face and lips on command. People with constructional apraxia are unable to copy, draw, or construct basic diagrams or figures.
What is apraxia in occupational therapy? ›
What is apraxia? Apraxia is the loss of ability to execute or carry out skilled movement and gestures, despite having the physical ability and desire to perform them.
How do you address ideational apraxia? ›Since the underlying cause of the disorder is damage to the brain, at present ideational apraxia is not reversible. However, Occupational or Physical Therapy may be able to slow the progression and help patients regain some functional control, with the treatment approach being the same as that of ideomotor apraxia.
What helps ideational apraxia? ›- Providing education to the individual and family regarding the mechanisms of apraxia is vital to minimize their frustration and depression.
- Breaking down functional tasks into steps.
- Using various tactile cues such as deep pressure and light touch to provide limb feedback (sensory stimulation)
Tips for dressing
Try verbal and physical prompts or reminders to guide the person to the next step in the sequence. For example guide their hand across the body to the affected side when dressing. Try a simple picture guide or list to help the person follow the correct order or sequence.
Radionic devices; chiropractors' rubbing plates; applied kinesiology; and radiesthesia, medical dowsing often with crystals; are examples of where the ideomotor effect is what is actually going on rather than real medical diagnosis.
What are the signs of ideomotor apraxia? ›Ideomotor apraxia is typically demonstrated when a patient is asked verbally to perform a gesture with a limb. Most authors also include the inability to imitate another person's gesture, to perform the appropriate action in response to a visually presented object, or to carry out a movement using the actual object.
What is the most common cause of ideomotor apraxia? ›Cause. The most common cause of ideomotor apraxia is a unilateral ischemic lesion to the brain, which is damage to one hemisphere of the brain due to a disruption of the blood supply, as in a stroke. There are a variety of brain areas where lesions have been correlated to ideomotor apraxia.
What causes constructional apraxia? ›Constructional apraxia, typically caused by a lesion in the right cerebral hemisphere, is the inability to construct elements in the correct fashion to form a meaningful whole—e.g., being unable to build a structure with blocks or to copy a design.
What are two characteristics of apraxia? ›Difficulty moving smoothly from one sound, syllable or word to another. Groping movements with the jaw, lips or tongue to make the correct movement for speech sounds.
What is constructional ability? ›The ability to copy or draw shapes, figures, or lines (e.g., with a pen and paper). This nonverbal ability depends on the integration of several higher brain functions, including perception, planning, and motor coordination. It is lost in organic brain syndromes.
Which therapy is more appropriate for the child with apraxia? ›
Children with CAS generally benefit from individual therapy. Individual therapy allows your child to have more time to practice speech during each session.
What does constructional apraxia impact? ›Constructional apraxia refers to the inability of patients to copy accurately drawings or three-dimensional constructions. It is a common disorder after right parietal stroke, often persisting after initial problems such as visuospatial neglect have resolved.
What causes dressing apraxia? ›Primary dressing apraxia is due to damage to the dorsal (superior) visual association cortex and pathways in the parietal lobe that impair attentional, spatial and kinesthetic analyses; the "where" system. (Table 141-1). Damage of either the right or left hemisphere produces disturbances in visuoconstructive tasks.
What is difference between praxis and apraxia? ›Praxis is defined as the ability to perform such skilled or learned movements. Apraxia refers to the inability to carry out such praxis movements in the absence of elementary motor, sensory or coordination deficits that could serve as the primary cause.
What is the difference between apraxia and dyspraxia? ›Dyspraxia is the partial loss of the ability to co-ordinate and perform skilled, purposeful movements and gestures with normal accuracy. Apraxia is the term that is used to describe the complete loss of this ability. The following may be affected: Gross and fine motor skills.
What is dressing Praxis? ›Dressing- refers to "an inability to dress oneself despite adequate motor skills and know-how" (Quintana, 2008, p. 743). Verbal- refers to the inability to coordinate the movements necessary to produce speech sounds so they may be distorted, repeated, or left out (PubMed Health, August 29, 2012).
Are there different levels of apraxia? ›Severity is usually described three categories: mild, moderate or severe. The number of sounds or words a child has does not determine severity, as this changes over time and often with age.
What are the three disorders that can occur alongside apraxia of speech? ›- Aphasia—language comprehension and/or production deficits.
- Dysarthria—motor speech disorder characterized by neuromuscular weakness or impaired coordination or control. ...
- Nonverbal oral apraxia—difficulty programming orofacial musculature for nonspeech movements.
The apraxia test consists of 2 subtests: demonstration of object use and imitation of gestures. The following daily objects are needed for testing: - spoon, hammer en scissors (demonstration pantomime) - eraser, comb and screwdriver (actual object use) - candle (imitation).
Where is the lesion in ideational apraxia? ›Ideational apraxia is a rare behavioural disturbance observed in patients with a lesion in the posterior part of the hemisphere dominant for language.
What is strategy training for apraxia? ›
'Strategy training' is an evidence-based standardized occupational therapy program originally designed by Van Heugten to supplement the existing rehabilitation program for apraxia in stroke patients [5].
What are the two types of apraxia? ›People with buccofacial apraxia, or facial-oral apraxia, are unable to make movements with the face and lips on command. People with constructional apraxia are unable to copy, draw, or construct basic diagrams or figures.
What are the symptoms of ideomotor apraxia? ›Symptoms. Ideomotor apraxia, also known as voluntary-automatic dissociation, is characterized by the inability to perform a variety of task-oriented physical movements, despite normal strength. People who have ideomotor apraxia may exhibit frustration, depression, or may simply give up on trying to do simple tasks.
What is the best treatment for apraxia? ›Speech therapy. Your child's speech-language pathologist will usually provide therapy that focuses on practicing syllables, words and phrases. When CAS is relatively severe, your child may need frequent speech therapy, three to five times a week. As your child improves, the frequency of speech therapy may be reduced.
What is constructional apraxia in childhood? ›Constructional apraxia is characterized by an inability or difficulty to build, assemble, or draw objects. Apraxia is a neurological disorder in which people are unable to perform tasks or movements even though they understand the task, are willing to complete it, and have the physical ability to perform the movements.
What does ideomotor apraxia tell us about the brain? ›Ideomotor apraxia (IMA) is the impaired ability to perform a skilled gesture with a limb upon verbal command and/or by imitation. It can be shown for both meaningful motor acts that do not imply objects and gestures that imply object use.