Apraxia Types

[Nadal Braymiller]

Bethlives in London and works as a freelance writer on a range of projects. Along with writing regular articles for Medical News Today, she writes for the Horniman Museum, an anthropology museum in South London. This involves recording minutes for conferences, blogging for their website, and documenting their process of curating art exhibitions. She loves theatre, yoga, and cycling in her spare time.

Dr. Heidi Moawad is a neurologist and teaches at Case Western Reserve University School of Medicine in Cleveland, Ohio. She serves on the editorial board of Neurology Clinical Practice and is a reviewer for Neurology.

Jamie is fascinated by the intersection of health and humanity. Before writing for Healthline, she completed a B.A. in English. She hopes her work will help increase health literacy and pave the way toward a healthy future for all. She is currently studying Public Health and Biostatistics.

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Apraxia is more common in older adults due to the higher incidence of neurological diseases, such as stroke and dementia, among this population. If people have apraxia due to swelling from a stroke, it might improve within a few weeks.

People with apraxia may find it difficult to control or coordinate movements voluntarily. These individuals may also have brain damage that causes aphasia, a language impairment that reduces the ability to understand or use words correctly.

People with limb-kinetic apraxia are unable to use a finger, arm, or leg to make precise and coordinated movements. Although people with limb-kinetic apraxia may understand how to use a tool, such as a screwdriver, and may have used it in the past, they are now unable to carry out the same movement.

The outlook for people with apraxia will vary depending on their individual circumstances. If a person has apraxia due to a stroke or another neurological disorder, treatment for this condition may help reduce or resolve apraxia symptoms.

Apraxia is a neurological condition that makes it difficult or impossible to make certain movements. This happens even though your muscles are normal and you have the understanding and desire to make these movements.

With apraxia of speech, sometimes called verbal apraxia, it's hard or impossible to move your mouth and tongue to form words. This happens even though you have the desire to speak and your mouth and tongue muscles are physically able to form words. There are two forms of apraxia of speech -- acquired apraxia and childhood apraxia of speech:

People with apraxia and aphasia might both have trouble expressing themselves with words. But there are differences between the two conditions. Aphasia is a condition that affects your ability to understand or use words effectively. This may make it hard to speak, read, or write.

But apraxia isn't a problem with understanding language. It's when you have a hard time starting and completing the movements needed to speak. This happens even though you don't have weakness in the muscles you use to speak.

Ongoing research is focusing on whether brain abnormalities that cause apraxia of speech can be identified. Other research is looking for genetic causes of this type of apraxia. Some studies are trying to determine exactly which parts of the brain are linked to the condition.

When you have apraxia, you have a hard time making certain movements. It happens when damage to your brain keeps it from giving the right instructions to your body. Different types of apraxia affect you in different ways. There's no cure, but physical, speech, and occupational therapy can improve your symptoms and make the condition easier to live with.

Apraxia is a motor disorder caused by damage to the brain (specifically the posterior parietal cortex or corpus callosum[1]), which causes difficulty with motor planning to perform tasks or movements. The nature of the damage determines the disorder's severity, and the absence of sensory loss or paralysis helps to explain the level of difficulty.[2] Children may be born with apraxia; its cause is unknown, and symptoms are usually noticed in the early stages of development. Apraxia occurring later in life, known as acquired apraxia, is typically caused by traumatic brain injury, stroke, dementia, Alzheimer's disease, brain tumor, or other neurodegenerative disorders.[3] The multiple types of apraxia are categorized by the specific ability and/or body part affected.

Apraxia is most often due to a lesion located in the dominant (usually left) hemisphere of the brain, typically in the frontal and parietal lobes. Lesions may be due to stroke, acquired brain injuries, or neurodegenerative diseases such as Alzheimer's disease or other dementias, Parkinson's disease, or Huntington's disease. Also, apraxia possibly may be caused by lesions in other areas of the brain.[11]

Ideomotor apraxia is typically due to a decrease in blood flow to the dominant hemisphere of the brain and particularly the parietal and premotor areas. It is frequently seen in patients with corticobasal degeneration.[11]

Ideational apraxia has been observed in patients with lesions in the dominant hemisphere near areas associated with aphasia, but more research is needed on ideational apraxia due to brain lesions. The localization of lesions in areas of the frontal and temporal lobes would provide explanation for the difficulty in motor planning seen in ideational apraxia, as well as its difficulty to distinguish it from certain aphasias.[14]

Constructional apraxia is often caused by lesions of the inferior nondominant parietal lobe, and can be caused by brain injury, illness, tumor, or other condition that can result in a brain lesion.[14]

Although qualitative and quantitative studies exist, little consensus exists on the proper method to assess for apraxia. The criticisms of past methods include failure to meet standard psychometric properties and research-specific designs that translate poorly to nonresearch use.[15]

The Test to Measure Upper Limb Apraxia (TULIA) is one method of determining upper limb apraxia through the qualitative and quantitative assessment of gesture production. In contrast to previous publications on apraxic assessment, the reliability and validity of TULIA was thoroughly investigated.[16] The TULIA consists of subtests for the imitation and pantomime of nonsymbolic ("put your index finger on top of your nose"), intransitive ("wave goodbye"), and transitive ("show me how to use a hammer") gestures.[15] Discrimination (differentiating between well- and poorly performed tasks) and recognition (indicating which object corresponds to a pantomimed gesture) tasks are also often tested for a full apraxia evaluation.[15]

However, a strong correlation may not be seen between formal test results and actual performance in everyday functioning or activities of daily living (ADLs). A comprehensive assessment of apraxia should include formal testing, standardized measurements of ADLs, observation of daily routines, self-report questionnaires, and targeted interviews with the patients and their relatives.[15]

As stated above, apraxia should not be confused with aphasia (the inability to understand language); however, they frequently occur together. Apraxia is so often accompanied by aphasia that many believe that if a person displays AOS, then the patient also having some level of aphasia should be assumed.[17]

Treatment for individuals with apraxia includes speech therapy, occupational therapy, and physical therapy.[18] Currently, no medications are indicated for the treatment of apraxia, only therapy treatments.[19] Generally, treatments for apraxia have received little attention for several reasons, including the tendency for the condition to resolve spontaneously in acute cases. Additionally, the very nature of the automatic-voluntary dissociation of motor abilities that defines apraxia means that patients may still be able to automatically perform activities if cued to do so in daily life. Nevertheless, patients experiencing apraxia have less functional independence in their daily lives,[20] and that evidence for the treatment of apraxia is scarce.[21] However, a literature review of apraxia treatment to date reveals that although the field is in its early stages of treatment design, certain aspects can be included to treat apraxia.[22]

One method is through rehabilitative treatment, which has been found to positively impact apraxia, as well as ADLs.[22] In this review, rehabilitative treatment consisted of 12 different contextual cues, which were used to teach patients how to produce the same gesture under different contextual situations.[22] Additional studies have also recommended varying forms of gesture therapy, whereby the patient is instructed to make gestures (either using objects or symbolically meaningful and nonmeaningful gestures) with progressively less cuing from the therapist.[23] Patients with apraxia may need to use a form of alternative and augmentative communication depending on the severity of the disorder. In addition to using gestures as mentioned, patients can also use communication boards or more sophisticated electronic devices if needed.[24]

No single type of therapy or approach has been proven as the best way to treat a patient with apraxia, since each patient's case varies. One-on-one sessions usually work the best, though, with the support of family members and friends. Since everyone responds to therapy differently, some patients will make significant improvements, while others will make less progress.[25] The overall goal for treatment of apraxia is to treat the motor plans for speech, not treating at the phoneme (sound) level. Individuals with apraxia of speech should receive treatment that focuses on the repetition of target words and rate of speech. The overall goal for treatment of apraxia should be to improve speech intelligibility, rate of speech, and articulation of targeted words.[26]

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