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Apraxia: Causes, Symptoms and Treatment

Apraxia is a neurological disorder in which individuals are unable to perform learned, purposeful movements correctly, despite having no paralysis or muscle weakness.

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Things worth knowing about "Apraxia"

Apraxia is a neurological disorder in which individuals are unable to perform learned, purposeful movements correctly, despite having no paralysis or muscle weakness.

What is Apraxia?

Apraxia is a neurological condition that impairs a person's ability to carry out learned and purposeful movements. Individuals with apraxia do not have paralysis (paresis) or muscle weakness, yet they are unable to perform familiar actions correctly. The condition results from damage to specific brain regions responsible for planning and coordinating movement.

Causes

Apraxia is generally caused by damage to the cerebral cortex or the neural pathways connecting brain areas. Common causes include:

Stroke (cerebrovascular accident): the most frequent cause
Traumatic brain injury
Brain tumors
Neurodegenerative diseases such as Alzheimer's disease, corticobasal degeneration, or Parkinson's disease
Inflammatory brain conditions (e.g., encephalitis)

Types of Apraxia

Several forms of apraxia exist, differing according to the brain region affected and the nature of the movement impairment:

Ideomotor apraxia: Individuals cannot correctly perform simple gestures on command (e.g., waving or imitating using a hammer), even though they understand the task.
Ideational apraxia: The sequencing of multi-step actions is disrupted (e.g., writing a letter, folding it, and placing it in an envelope).
Constructional apraxia: Difficulty with drawing, building, or assembling objects.
Orofacial apraxia (buccofacial apraxia): Impaired voluntary movements of the mouth and face (e.g., whistling or sticking out the tongue on command).
Gait apraxia: Impaired ability to walk in a coordinated manner despite intact motor function.
Apraxia of speech (verbal apraxia): Disruption of the motor planning required for producing speech sounds.

Symptoms

Symptoms vary depending on the type of apraxia but commonly include:

Errors or loss of control during familiar actions
Difficulty imitating gestures
Problems with the correct sequence of action steps
Speech difficulties despite intact language comprehension
Problems with writing or drawing
Difficulties with dressing or undressing (dressing apraxia)

Diagnosis

Apraxia is diagnosed by a neurologist or neuropsychologist. The following assessments are typically used:

Clinical neurological examination including standardized apraxia screening tools
Brain imaging such as MRI (magnetic resonance imaging) or CT (computed tomography)
Neuropsychological testing to assess cognitive and motor abilities

Treatment

A curative treatment for apraxia is not always possible. The focus lies on rehabilitative therapy:

Occupational therapy: Training of everyday activities and compensatory strategies
Speech and language therapy: Particularly for speech or orofacial apraxia
Physiotherapy: Improvement of movement coordination, especially for gait apraxia
Treatment of the underlying condition (e.g., stroke management, tumor resection)
Supportive measures in daily life provided by caregivers and assistive devices

Prognosis

The prognosis of apraxia depends strongly on the underlying cause, the extent of brain damage, and the timing of rehabilitation. In stroke-related apraxia, many patients can achieve significant improvement through intensive therapy. In neurodegenerative diseases, the prognosis is generally less favorable, as symptoms tend to worsen over time.

References

Goldenberg, G. (2013): Apraxia: The Cognitive Side of Motor Control. Oxford University Press.
Heilman, K.M. & Rothi, L.J.G. (2003): Apraxia. In: Clinical Neuropsychology (4th ed.). Oxford University Press.
National Institute of Neurological Disorders and Stroke (NINDS): Apraxia Information Page. Available at: https://www.ninds.nih.gov (accessed 2024).

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