Apraxia

What is Apraxia?

Apraxia is a condition where someone can’t carry out skilled actions, regardless of whether they know how to do them or can mimic someone else doing it. To diagnose apraxia, doctors need to make sure that the problem isn’t caused by weakness, a sensory disorder, a comprehension issue, or lack of coordination. Historically, apraxia was divided into three types by Hugo Karl Liepmann – limb-kinetic, ideomotor, and ideational. Liepmann’s categorizations set the foundation for how we understand apraxia today, although now there are more subtypes recognized. Depending on the task being performed or the action being taken, apraxia can present differently. However, there’s no standard way to define these subtypes.

Some major types of apraxia include:

• General Apraxia
• Ideational – Forgetting how to carry out a known skill
• Ideomotor – Difficulty connecting the idea of a skill to the action
• Limb-kinetic – Lost control over movements related to a skill
• Conceptual – Not being able to use tools
• Task-specific Apraxia
• Speech issues
• Difficulty with drawing, building, or copying

Sometimes, “ideational apraxia” and “conceptual apraxia” are used interchangeably to refer to difficulties with performing a sequence of actions or understanding the concept of an action, respectively. However, these terms aren’t always used consistently.

Performing skilled actions requires certain areas of the brain to be active. The type of apraxia you develop can depend on which parts of the brain are affected. To diagnose apraxia, doctors do a comprehensive check-up that includes taking a detailed history, performing a neurological examination, and conducting tests specific to apraxia – though medical professionals don’t always agree on the best ways to do this.

Treating apraxia involves dealing with its root cause through things like physical therapy, occupational therapy, or other specific treatments, combined with counseling. How well someone recovers from apraxia can depend on what type they have and how it affects their daily life. Other associated problems can range from difficulties with math and writing, speaking, disorientation, social anxiety, and low self-esteem. In some cases, people with apraxia may need long-term care.

What Causes Apraxia?

Apraxia, a motor disorder, can be caused by several conditions, including:

* Stroke
* Corticobasal syndrome
* Alzheimer’s disease
* Huntington’s disease
* Multiple sclerosis
* Tumors
* Creutzfeldt-Jakob disease
* Schizophrenia
* Traumatic brain injury

The likelihood of developing a certain type of apraxia is connected to the risk of developing the disease that’s behind it. For example, if you have a high risk of stroke, your chance of developing stroke-related apraxia might also be high.

Risk Factors and Frequency for Apraxia

Apraxia, a type of movement disorder, is a common condition that is often seen in individuals who have had certain types of medical conditions. For instance:

• About 50% to 80% of people who have had a stroke in the left side of their brain may develop apraxia.
• About 30% to 50% of people who have had a stroke in the right side of their brain may also be affected.
• Apraxia is also common in people with brain injuries, affecting between 19% to 45% of these individuals.
• It affects about 25% of those diagnosed with multiple sclerosis.
• And, it’s prevalent in up to 90% of people diagnosed with dementia.

However, there’s not enough data to indicate how common apraxia is in the general population.

Signs and Symptoms of Apraxia

Doctors can start examining a patient for apraxia, a condition where a person struggles to perform learned movements, once they’re confident that the issues are not due to sensory, motor, or cognitive problems. The patient needs to show understanding and the ability to carry out tasks used in the test before the examination can begin. Both sides of the body should be evaluated.

There are two types of actions doctors look at: actions that are mimicked directly and actions recalled from memory. These actions fall under three categories:

• Intransitive gestures (symbolic gestures) which do not require an object, such as saluting or waving goodbye
• Transitive gestures which involve using an object, like swinging a hammer or flipping a coin
• Pantomime, which is imitating or replicating the use of tools or objects in their absence

On top of these, doctors also may look at meaningless gestures like putting your thumb on the underside of your nose.

There are several types of apraxia, each with its own specific symptoms:

• Ideomotor apraxia: patients have trouble mimicking or replicating gestures and may also have difficulty with movements involving their fingers, hands, and arms
• Ideational apraxia: patients struggle to understand the right order of actions needed to do a task and may encounter issues organizing the required steps even when provided with them
• Limb-kinetic apraxia: patients have trouble with fine motor movements, particularly with their hands, when trying to perform a familiar task
• Conceptual apraxia: patients have difficulties recognizing the correct tool for a task and may have trouble mimicking the correct use of a tool

There are various formal tests for limb apraxia including the Florida Apraxia Battery-Extended and Revised Sydney (FABERS), the Apraxia Battery for Adults-2, the Short Screening Test for Ideomotor Apraxia (STIMA), the Cologne Apraxia Screening (KAS) or Revised Cologne Apraxia Screening (KAS-R), the Diagnostic Instrument for Limb Apraxia (DILA) or the Diagnostic Instrument for Limb Apraxia-Short Version (DILA-S), and the Test of Upper Limb Apraxia (TULIA).

Testing for Apraxia

To diagnose a condition known as apraxia, doctors use several thorough assessment methods. They may take a close look at your medical history, perform a physical examination, and conduct neuropsychological testing. This process not only helps in identifying apraxia but also classifying it.

Apraxia can present itself in different ways. For example, it might appear suddenly after a severe event affecting the brain, like a stroke or traumatic brain injury. On the other hand, it can also develop slowly, as seen in brain disorders causing gradual damage.

Often, patients are not aware that they’ve lost their ability to perform tasks they’d learned before.

Additional testing, including radiological and laboratory evaluation, helps figure out what’s causing the apraxia. This could be various conditions like cerebrovascular disease, brain disorders causing gradual damage, traumatic brain injury, tumors, or multiple sclerosis.

Imaging techniques like MRI and PET scans can track down brain lesions associated with apraxia. MRI is used to capture detailed images of the brain, and the PET scan produces images showing the function of different parts of the brain.

Treatment Options for Apraxia

The main treatment for apraxia, a condition that can affect a person’s ability to perform certain movements, involves comprehensive rehabilitation using various therapies. These can include occupational therapy, speech therapy, and physical therapy. They also address the root cause of the disorder. Apraxia can greatly impact a person’s ability to live independently. If it’s present after a stroke, it usually means that the person will need help from a caregiver. On the other hand, if apraxia isn’t present, it could mean that they can return to work sooner.

Despite this, there isn’t currently a widely agreed-upon treatment approach for apraxia. The challenge lies in creating therapies that are specific to certain tasks but also provide benefits that can apply to other areas of a person’s life. This has been the focus of several studies. The rehabilitation process should ideally begin as soon as possible after apraxia is diagnosed, especially in cases where it arises after sudden brain injuries. More recent technologies like transcranial magnetic stimulation, a non-invasive procedure that uses a magnetic field to stimulate nerve cells in the brain, are showing promise in treating apraxia.

What else can Apraxia be?

When looking into conditions that affect movement or speech, doctors have to be careful not to confuse apraxia (a motor disorder) with other similar disorders. These could include the following:

• Aphasia (a speech disorder)
• Nonapraxic dysarthria (another speech difficulty)
• Alien limb syndrome (involuntary limb movements)
• Akinesia (trouble moving muscles properly)
• Magnetic grasp (involuntary grasping response)
• Grope reflex (inability to control hand or arm)
• Motor preservation (repeating movements without meaning to)
• Motor impersistence (being unable to hold a position or gesture)

These conditions may seem alike, but through careful examination and testing, doctors can accurately identify apraxia and not mistake it for these other conditions.

What to expect with Apraxia

People suffering from apraxia may experience severe difficulties in performing tasks they’ve learned before. This can greatly impact their independence and their ability to conduct daily activities. It’s crucial to put in place suitable safety measures to prevent possible injuries from objects and activities around them.

In certain cases where the inability to carry out learned skills becomes too disabling, the individual may need professional nursing care. The outlook varies from person to person, and depends on the underlying disease causing the apraxia.

Possible Complications When Diagnosed with Apraxia

Apraxia can lead to several outcomes, which can seriously affect a person’s daily life:

• Difficulty carrying out everyday tasks
• Issues with performing adequately at work
• Injuries due to incorrect use of tools or equipment
• Becoming socially isolated
• Developing social anxiety
• Having low self-esteem

Preventing Apraxia

Apraxia, which is an inability to carry out specific tasks, is usually caused by a stroke, dementia, or a head injury. This condition can be hard to manage because it’s often a sign of a more serious problem with the brain. It’s important to learn about and change any habits that might increase the risk of these diseases. This can include taking medication, handling conditions like high blood pressure and diabetes, getting enough sleep, managing irregular heartbeats, and reducing smoking and drinking alcohol. These changes can lead to better health outcomes.

Regardless of the cause, having apraxia can be very frustrating because it can lead to a loss of skills, lack of motivation, depression, and further decline in function. It can be very helpful to use educational materials, clear communication with caregivers, and family counseling to understand what to expect, set realistic goals, and prepare for the challenges of recovery. Active involvement by patients, caregivers, and family members can make a big difference in helping the recovery process.