Apraxia is a neurological condition that affects the ability of a person to perform certain activities, such as movements, gestures, and speech, regardless of having the physical capacity and desire to perform them without abnormal sensory, motor, and cognitive functioning. Apraxia condition is caused by the failure of proper functioning of the brain’s cerebral hemispheres and mostly the parietal lobe, which functions to coordinate movement, sensations (speech, touch, and hearing) and gestures. The dysfunction of the brain is caused by injuries, which makes it unable to send the correct instructions to the body to perform various response actions such as movement, speech, and gestures. Cerebral dysfunction is caused by various factors, which include brain tumors, stroke, and neurocognitive diseases such as dementia, Alzheimer’s, multiple sclerosis, schizophrenia, and injuries to the brain through accidents that develop abnormal brain lesions. Apraxia is classified according to task-specific actions and general actions (Gowda & Schneider, 2023). Task-specific actions classify apraxia as a disorder that affects speech (interrupted speech), gait (inability to lift the feet from the ground), and apraxia agnosia (the inability to understand written material). General actions classify apraxia as decreased motor skills (ideomotor), loss of the ability to use tools that involve a series of actions (ideational), inability to imitate movements (conduction apraxia), and inability to gesture normally to commands (disassociation apraxia).
Apraxia affects children and adults, and therefore, this suggests that apraxia can be acquired as a person grows or can be developed at a young age. Apraxia in children is caused by genetic variations and neurodevelopmental disorders that affect children at a young age. Genetic disorders in children develop when the child inherits abnormal genetic composition from the parents. Also, neurodevelopmental disorders affect the central nervous system in children, thus leading to apraxia. On the other hand, acquired apraxia, as seen in adults, is caused by brain injuries due to accidents such as cerebrovascular and traumatic brain injuries, the development of brain tumors at adult stages, and the onset of neurodegenerative diseases. Thus, from this information, people susceptible to apraxia include older people due to the risk of old age diseases such as stroke, dementia, and schizophrenia, prone to injuries due to daily activities that might injure the brain (Gowda & Schneider, 2023).
Symptoms
The symptoms of apraxia depend on the type of apraxia, as there are many types due to the disorder’s impacts on different parts of the body. As apraxia affects movements, sensory, and speech, the parts that perform these body actions are the ones that exhibit the symptoms. Decreased gross motor skills are the first symptoms of apraxia, whereby the patient experiences difficulty in walking, running, and moving more slowly than usual. The second symptom is difficulty in performing fine motor skills such as using tools to write, inability to dress, clean, shoe lacing, and use a computer to write, among other activities. The third symptom is having speech difficulties whereby the patient experiences difficulty in pronouncing words, joining words to communicate clearly, omitting words, and repeated attempts to pronounce words despite the patient being able to understand the commands. The fourth symptom of apraxia is buccofacial problems whereby the patient develops difficulties in making facial expressions, smiling, whistling, licking their lips, and other oral motor-controlled activities. The fifth symptom is that the patient finds it difficult to move their eyes (National Institute of Health, 2023).
Assessment and Diagnosis
Apraxia is assessed and diagnosed by conducting a comprehensive neurological examination to disregard other problems in the body, such as motor, sensory, and cognitive problems in the patient. After confirming the absence of these three dysfunctions in the patient’s body, the assessment and diagnosis of apraxia starts, whereby the patient is examined to ensure they have the ability and capacity to understand commands and ability to execute these commands (Allison et al., 2020). If the patient is able to understand and execute tasks, physical testing commences in stages to test the various types of apraxias, such as ideomotor, ideational, conceptual, limb-kinetic, and dissociation. In addition, testing starts with the most severe type to the less severe. The first step is to ensure the patient understands verbal instructions, and then after this step, the patient is tested on their ability to imitate gestures (ideomotor) and identify them. The patient is subjected to gestures, and if they are unable to imitate and act on these gestures, then they have ideomotor apraxia. In diagnosing ideational apraxia, the patient can be asked to make bread, and if they do not follow the correct steps, they have this type of apraxia. Diagnosing conceptual apraxia is done by subjecting the patient to the use of tools like a hammer to drive in a nail, and if they have difficulties in using it, then the patient has conceptual apraxia. Testing Dissociation apraxia is done by giving verbal instructions, and if the patients fail to playact the instructions, then they have this type of apraxia. Lastly, diagnosis of limb-kinetic apraxia is done by subjecting the patient to a fine motor action such as picking a pen, and if the patient slides the pen first and then picks it, then they have inaccurate movements, which diagnoses limb-kinetic apraxia (Gowda & Schneider, 2023).
Treatment of Apraxia
Apraxia as a neurological disorder lacks a pharmacological intervention, and therefore, managing this disorder requires identifying and treating some of the underlying diseases and conditions caused by neurological problems. However, treating the neurological problems may be combined with therapy treatments for effective management of the condition. Neuropsychology focuses on the behavior and cognition of a person and how they relate to the central nervous system. Thus, treating apraxia using a neuropsychological perspective will include neuroplasticity, which is a process to help the brain reorganize itself with new neural connections concerned with motor planning and execution. This is done by using a method called “Constraint-Induced Movement Therapy (CIMT).” CIMT may help treat limb-kinetic apraxia by actively practicing the affected limb while inhibiting the use of the active limb. In this way, the brain relies on the affected limb’s system to create new neural connections, which get strengthened over time and promote learning, leading to improved motor control (Tariq et al., 2023). The second neuropsychological treatment is through motor imagery, whereby the patient imagines making movements using the affected limb by apraxia without physically moving the limb. The imagination activates neural networks and connections used in actual movement, and this makes the brain improves its neural connections over time, thus improving the motor skills of the affected limb (Wang et al., 2023). Neuropsychological treatment of apraxia requires the creation of new neural connections in the brain due to the repeated use of some procedures to improve neuroplasticity, which is the ability of the brain to reorganize neural networks and strengthen them over time after subjecting the brain to learning activity.
References
Tariq, A., Talpur, M. A. H., Jahan, S., & Ghous, M. (2023). Effects of rood’s sensory motor training along with constraint-induced movement therapy in sub-acute stroke. Rawal Medical Journal, 48(3), 606-606.
Wang, H., Xiong, X., Zhang, K., Wang, X., Sun, C., Zhu, B., & Sun, L. (2023). Motor network reorganization after motor imagery training in stroke patients with moderate to severe upper limb impairment. CNS Neuroscience & Therapeutics, 29(2), 619-632.
Allison, K. M., Cordella, C., Iuzzini-Seigel, J., & Green, J. R. (2020). Differential diagnosis of apraxia of speech in children and adults: A scoping review. Journal of Speech, Language, and Hearing Research, 63(9), 2952-2994.
National Institute of Health. (2023 January 31). Apraxia. National Institute of Neurological Disorders and Disorder. https://www.ninds.nih.gov/health-information/disorders/apraxia#
Gowda SN, Kolton Schneider L. Apraxia. [Updated 2023 August 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK585110/
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