Apraxia: Types, Signs, Symptoms, Causes, Diagnosis, Treatment and Prognosis

Patients with this disorder cannot use tools or perform acts such as tying shoelaces or button-down shirts, among others.

Apraxia is a neurological disorder characterized by the inability to perform movements learned in the development of the individual, although the instructions are understood and there is the will to perform the movement.

Both the desire and the ability to move are present, but the person simply cannot perform the act.

The requirements of daily life are difficult to meet. Patients whose ability to speak is disrupted (aphasia) but who are not affected by apraxia can live relatively normal lives.

Individuals who have significant apraxia are almost always dependent.

Types of apraxia

Apraxia comes in several different forms:

Limb apraxia-kinetics

It is the inability to make precise or exact movements with a finger, an arm or a leg.

An example is the inability to use a screwdriver even though the affected person understands what to do and has done it in the past.

The ideomotor engine apraxia

It is the inability to carry out a command of the brain to imitate the movements of the limb or head made or suggested by others.

La apraxia conceptual

This is very similar to ideomotor apraxia, but infers a deeper malfunction in which the function of the tools is no longer understood.

The ideational apraxia

It is the inability to create a plan for a specific movement.
Orofacial apraxia, sometimes called facial-oral apraxia, is the inability to coordinate and perform facial and lip movements, such as whistling, winking, coughing, among others.

This form includes apraxia of speech or verbal development, perhaps the most common form of the disorder.

Constructive apraxia

This affects a person’s ability to draw or copy simple diagrams or to build simple figures.

La apraxia oculomotora

It is a condition in which patients find it difficult to move their eyes.

Apraxia is believed to be caused by injury to neural pathways in the brain that contain learned movement patterns. It is often a symptom of neurological, metabolic, or other disorders that can affect the brain.

Signs and symptoms

The main symptom of apraxia is the inability of a person to perform movements in the absence of physical paralysis.

Orders to move are understood, but cannot be executed.

When the movement starts, it is usually very clumsy, uncontrolled, and inappropriate. In some cases, the movement can occur unintentionally.

Sometimes apraxia is accompanied by a loss of a person’s ability to understand or use words (aphasia).

Specific types of apraxia are characterized by the inability to perform particular movements. For example, in orofacial apraxia, an affected person is unable to cough, hiss, lick his lips, or wink when prompted.

In constructive apraxia, an individual cannot reproduce simple patterns or copy simple pictures.

Diagnosis of apraxia

An evaluation of the medical history and symptoms is performed by a physician.

To diagnose apraxia, tests are performed where doctors evaluate the patient, such as brain function tests (neuropsychological tests), asking them to do or reproduce common tasks already learned, such as using a toothbrush, scissors or a screwdriver.

Doctors also perform a physical exam to determine if symptoms are caused by muscle weakness or a muscle or joint problem.

Family members or caregivers are asked how well the person performs daily activities, such as eating with utensils, preparing meals, and writing.

To determine what is the cause of brain damage, imaging tests are done, such as CT scan or MRI.

Causes

Apraxia is caused by damage to areas of the brain that contain memory of learned movement patterns.

Most apraxias are the result of damage to parts of the brain associated with higher-order motor skills.

These include the so-called supplementary motor area (premotor cortex) or the corpus callosum.

The injury may be the result of certain disorders that affect the brain, particularly the frontal lobe (lower parietal lobe) of the left hemisphere of the brain.

In this region, complex three-dimensional representations of previously learned patterns and movements are stored.

Tissue or cell damage to other specific parts of the brain, whether as a result of stroke , injury, tumors, or dementia, can also cause apraxia.

Neurological diseases that cause degeneration of the brain, such as dementia, can cause a variety of problems, such as changes in personality, changes in cognition, inability to speak, or apraxia.

Patients with apraxia cannot retrieve these stored qualified movement patterns. Only in cases where apraxia is the result of a stroke does it decrease within a few weeks.

Some cases of apraxia are congenital. When a child is born with apraxia, it is usually the result of malformations of the central nervous system.

Oculomotor apraxia is a dominant genetic trait. The gene for this condition has been mapped onto chromosome 2p13.

Each chromosome has a short arm designated as “p” and a long arm designated as “q”. Chromosomes are subdivided into many bands that are numbered.

For example, “chromosome 2p13” refers to band 13 on the short arm of chromosome 2. The numbered bands specify the location of the thousands of genes that are present on each chromosome.

Genetic diseases are determined by two genes, one received from the father and one from the mother.

Dominant genetic disorders occur when only one copy of an abnormal gene is needed for the disease to develop.

The abnormal gene can be inherited from either parent or it can be the result of a new mutation (change in the gene) in the affected individual.

The risk of transmitting the abnormal gene from affected parents to offspring is 50% for each pregnancy, regardless of the sex of the resulting child.

When a blood vessel in the brain is blocked by a clot or when a blood vessel bleeds into the brain, the brain does not get enough oxygen.

The brain needs oxygen and dies rapidly within minutes of the oxygen flow being cut off.

If a stroke occurs in the part of the brain that controls motor skills or use of tools, apraxia can occur.

People with a condition of impaired intellectual functioning (degenerative dementia) may also develop

Other serious disorders of the normal and healthy state of the body can cause symptoms similar to apraxia, since brain function can be significantly worse when a person is seriously ill.

Metabolic imbalances in the body can affect the brain and lead to apraxia, such as:

  • Electrolyte imbalance : Severe electrolyte or blood sugar imbalance can lead to cognitive deficits such as apraxia.
  • Severe Trauma Infection: Serious disorders of your body’s health can lead to various cognitive deficits, such as apraxia.

In rare cases, apraxia can be a side effect of a serious psychiatric disorder, called a conversion disorder.

Affected populations

Few data are available on the incidence of apraxia. Since apraxia can accompany dementia or stroke, it is most often diagnosed among older people.

Related disorders

Some disorders may be associated with apraxia as a secondary feature such as aphasia.

Aphasia is a disorder in the ability to understand or use language.

It usually occurs as a result of damage to the language centers of the brain (cerebral cortex).

Affected people may select the wrong words for conversation and may have trouble interpreting verbal messages.

Children born with aphasia cannot speak at all. A speech therapist can assess the quality and extent of aphasia and help educate the people who most commonly interact with the affected person on methods to aid communication.

Treatment of apraxia

Speech therapists can help people who have verbal apraxia by asking them to practice making sound patterns over and over again.

If the verbal apraxia is severe, people can be taught to use a chart or picture board or an electronic communication device with a keyboard and message display.

When apraxia is a symptom of an underlying disorder, that disease or condition needs to be treated.

Physical and occupational therapy can be beneficial for stroke and head injury patients.

When apraxia is a symptom of another neurological disorder, the underlying condition must be treated.

In some cases, children with apraxia can learn to compensate for deficits as they grow with the help of special education programs and physical therapy.

Speech therapy and special education can be particularly helpful in treating patients with developmental apraxia of speech.

Forecast

Depending on the cause, some people with apraxia continue to learn function and become dependent, requiring help with daily activities and some supervision.

However, if apraxia is the result of a stroke, people may not continue to lose function and may even improve somewhat.