What is Apraxia? Why Does It Happen?

Praxis is the planning and execution of voluntary movements that require skill. Apraxia, on the other hand, is the inability to perform the movements that one has learned before, despite having sufficient understanding, desire and movement capacity when told to do it. Damage to the nerve pathways associated with learned movements in the brain can cause apraxia.

People with apraxia may not be able to perform activities of daily living such as buttoning up and tying shoes. Therefore, they can become dependent on other people.

Types of Apraxia

There are different types. These can be found alone or a combination of several in an individual.

Limb -movement apraxia is the inability to perform certain movements with fingers, arms or legs. For example, it is a kind of limb-movement apraxia that a person who has used a screwdriver many times before cannot use a screwdriver even though his comprehension function is preserved. Skills such as using the keyboard and tying shoes are affected.

In ideomotor apraxia , the movements made or desired to be performed by others cannot be performed. There is a problem in converting the action plan in the brain into action. The problem is evident when the person is asked to imitate. But he can somehow start automatically and do the same. For example, when asked to pick up the phone, it cannot do so, but when the phone rings, it can open it automatically without thinking.

Conceptual apraxia: Similar to ideomotor apraxia, but there is a problem with conceptualization of work. It cannot complete multi-step movements. It can confuse the order of movements. For example, he can put on shoes before putting on socks. Previously known skills cannot be done once the necessary tools are given. When given a screwdriver, he can hold it like a pen and try to write.

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Buccofacial apraxia or face-mouth apraxia is the inability to make coordinated facial and lip movements such as whistling, coughing, and blinking on command. This form is the most common apraxia. Speech apraxia can be classified as a subtype.

Structural apraxia affects a person’s ability to draw or copy simple shapes.

Apraxia of gait: Inability of the legs to perform normal functions such as walking, despite the absence of muscle strength or sensory loss.

Oculomotor apraxia affects eye movements. Short and fast movements of the eye become difficult for object tracking.

Signs and Symptoms

The main symptom of apraxia is the inability to perform certain movements, although there is no paralysis. Motion commands are understandable but not enforceable. When the movement is initiated, it is often clumsy, uncontrolled, and inappropriate. In some cases, the movement can be done spontaneously without wanting it. This is called auto-volitional dissociation.

Why Does It Happen?

Apraxia develops due to problems in the nerve circuits in the brain that store learned movement patterns. Metabolic, neurological, or other diseases that affect the brain can lead to it. In particular, damage to the frontal and parietal lobes (inferior parietal lobule) in the non-dominant (usually right) hemisphere is associated with apraxia. These regions are where pre-learned, 3-dimensional representations of complex movement patterns are stored. Patients with apraxia cannot use these movement patterns to perform certain skills. Conditions affecting the supplementary motor area and corpus callosum may also cause apraxia.

Some types of apraxia may be present from birth. Oculomotor apraxia is a dominant genetic trait.

Stroke , trauma , tumor that causes damage to the brain tissue can be the cause of apraxia. Apraxia caused by stroke may improve within weeks. Apraxia can also be seen in dementia-causing diseases such as Alzheimer’s disease , Parkinson’s disease, Huntington ‘s disease .

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Diagnosis

Although there are qualitative and quantitative criteria to determine apraxia, there is no consensus among experts in terms of determining a standard diagnostic method. TULIA (The Test to Measure Upper Limb Apraxia) can be used to identify apraxia affecting the arm. In addition, standard tests that measure the degree of independence of the person in activities of daily living should also be used. Apraxia is often accompanied by aphasia , which is a speech and language disorder . It is also recommended that people with apraxia be evaluated for aphasia.

Treatment

If apraxia is the result of another disease, such as a stroke, tumor, or brain injury, the symptoms of apraxia may be alleviated with comprehensive treatment of the underlying disease. Physical therapy and rehabilitation, occupational and occupational therapy are effective in stroke and brain injury patients . Apraxia that affects children due to developmental disorders in the brain can be improved with special education and physical therapy program or compensatory techniques can be taught. Speech therapy is used for developmental apraxia of speech. Preserving the ability of patients to perform movements automatically may enable the initiation of automatic behaviors by using various cues and thus increasing the independence of daily life.

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