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apraxia
A disorder of learned movement (praxis) unexplained by deficits in strength, coordination, sensation, or comprehension.
Classification:
1) limb-kinetic apraxia
2) ideomotor apraxia
3) ideational apraxia
4) buccofacial apraxia* (facial-oral apraxia)
5) verbal apraxia
6) constructional apraxia
7) oculomotor apraxia
* most common form
Etiology:
- neurodegenerative diseases
- Alzheimer's disease
- Parkinson's disease
- Huntington's disease
- corticobasal degeneration (ideomotor apaxia)
- brain neoplasm
- stroke
- traumatic brain injury [5]
Pathology:
- white matter lesion(s)
a) deep in the left parietal lobe
b) beneath the premotor cortex
c) lesions of the corpus callosum
- decrease in blood flow to the left hemisphere, especially the parietal & premotor areas (ideomotor apraxia)
Procedure:
Brief assessment:
1) pantomime use of a toothbrush, comb, hammer &/or scissors with each hand
2) patients with apraxia fail the test altogether or may susbtitute their hand for the object (i.e. placing their finger in their mouth for 'toothbrush')
Praxis battery:
1) buccofacial
a) use of objects
- blow out match
- suck on straw
- sniff flowers
b) symbolic gestures
- stick out tongue
- blow a kiss
- wink
c) other
- whistle
- show teeth
- lick lips
2) upper limb
1) use of objects
- brush teeth
- comb hair
- flip coin
- cut paper
- hammering
- sawing
- turn knob
2) symbolic gestures
- salute
- wave
- hitchhike
- thumbs-up sign
- make a fist
- 'stop' sign
- 'V' sign
- beckon
3) other
- snap fingers
- touch ear
- hold up thumb
- hold up little finger
3) lower limb
1) use of objects
- kick ball
- put out cigarette
2) symbolic gestures
- figure 8
4) whole body
a) use of objects
- swing bat
- sweep
b) symbolic gestures
- bow
- stand like a boxer
c) other
- stand or sit
- turn around
Management:
1) physical therapy &/or occupational therapy
2) identify & treat underlying disorder
3) prognosis is variable
a) with therapy, some patients improve significantly
b) others show very little improvement with therapy
Related
developmental dyspraxia
Specific
buccofacial apraxia (facial-oral apraxia)
constructional apraxia
ideational apraxia
ideomotor apraxia
limb kinetic apraxia
oculomotor apraxia
verbal apraxia
General
sign/symptom
References
- nlmpubs.nlm.nih.gov/hstat/ahcpr/
- Cummings, Hospital Practice, May 1993, pg 56-68
- Comprehensive Geriatric Assessment, Osterweil et al eds,
McGraw Hill, New York, 2000, pg 81
- Wikipedia: Apraxia
http://en.wikipedia.org/wiki/Apraxia
- MedlinePlus: Apraxia
http://www.nlm.nih.gov/medlineplus/ency/article/007472.htm
- WebMD
Apraxia: Symptoms, Causes, Tests, Treatments
http://www.webmd.com/brain/apraxia-symptoms-causes-tests-treatments
- NINDS Apraxia Information Page
https://www.ninds.nih.gov/Disorders/All-Disorders/Apraxia-Information-Page