What Is Apraxia?

Apraxia is a neurological disorder characterized by loss of the ability to execute or carry out skilled movements and gestures, despite having the desire and the physical ability to perform them.

There are several kinds of this condition, which may occur alone or together.

The most common type is buccofacial or orofacial apraxia, which causes the inability to carry out facial movements on command such as licking lips, whistling, coughing, or winking. Other types of include:

  • limb-kinetic (the inability to make fine, precise movements with an arm or leg)
  • ideomotor (the inability to make the proper movement in response to a verbal command)
  • ideational (the inability to coordinate activities with multiple sequential movements, such as dressing, eating, and bathing)
  • verbal (difficulty coordinating mouth and speech movements)
  • constructional (the inability to copy, draw, or construct simple figures)
  • oculomotor (difficulty moving the eyes on command).

Apraxia may be accompanied by a language disorder called aphasia. Corticobasal ganglionic degeneration is a disease that causes a variety of types of apraxia, especially in elderly adults.

Treatment For Apraxia

Treatment for individuals with apraxia includes speech therapy, occupational therapy, and physical therapy. Generally, treatments 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 this condition means that patients may still be able to automatically perform activities if cued to do so in daily life. Nevertheless, research shows that patients experiencing apraxia have less functional independence in their daily lives, and that evidence for the treatment of apraxia is scarce.

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.

One method is through rehabilitative treatment, which has been found to positively impact apraxia, as well as activities of daily living. In this review, rehabilitative treatment consisted of 12 different contextual cues, which were used in order to teach patients how to produce the same gesture under different contextual situations.

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 non-meaningful gestures) with progressively less cuing from the therapist. It may be necessary for patients 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. 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.

However, one-on-one sessions usually work the best, 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. The overall goal for treatment is to treat the motor plans for speech, not treating at the phoneme (sound) level.

Research suggests that individuals with apraxia of speech should receive treatment that focuses on the repetition of target words and rate of speech. Research suggested that the overall goal for treatment should be to improve speech intelligibility, rate of speech and articulation of targeted words.

Causes

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. It is also possible for apraxia to be caused by lesions in other areas of the brain including the non-dominant (usually right) hemisphere.

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.

Ideational apraxia has been observed in patients with lesions in the dominant hemisphere near areas associated with aphasia; however, 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 the ideational form, as well as its difficulty to distinguish it from certain aphasias.

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

Duffy, Joseph R.
Motor Speech Disorders: Substrates, Differential Diagnosis, and Management
St. Louis, MI: Elsevier. ISBN 978-0-323-07200-7