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This page will provide you with a comprehensive overview on the types of motor apraxia, the symptoms of motor apraxia, the treatment of motor apraxia and motor apraxia prognosis as it pertains to stroke. We sincerely hope that our website helps to further your understanding on the topic of motor apraxia. If you have further questions, please contact a healthcare professional.
What is Motor Apraxia?
Apraxia, also called motor apraxia, is a complex higher order cognitive-motor deficit commonly associated with dementia and stroke. Patients with this condition have difficulties performing tasks or movements when asked to. More specifically, patients with motor apraxia have problems with the motor planning component of an action because messages relayed from the brain to their respective muscles are interrupted. For example, a patient with motor apraxia cannot produce sounds correctly in speech when asked to because the message does not correctly relay to the mouth muscles, which are strong enough to perform the action. Motor apraxia is caused by damage to specific areas of the cerebrum, particularly the posterior parietal cortex. Motor apraxia is a common result of stroke (both left side brain stroke and right side brain stroke), head trauma and brain tumors. For the purpose of this discussion, we will focus on motor apraxia as it pertains to stroke.
Characteristics of Apraxia
There are many important characteristics of apraxia that differentiate it from other similar diseases such as aphasia (a communication disorder), abulia (lack of desire to act), ataxia (lack of coordination) and allochiria (a condition where stimuli is perceived to be from the wrong side of the body). For example, one of the characteristics of apraxia that differentiates it from aphasia is that motor apraxia patients can comprehend language but cannot initiate or perform the actions needed for speech, whereas aphasia patients can perform the action but cannot comprehend language. It is common for apraxia and aphasia to be confused because they both often occur concomitantly in patients after stroke. Similarly, patients with motor apraxia have the muscles to perform the action and the desire to perform but patients with ataxia and abulia do not, respectively.
Another common condition that is confused with motor apraxia is dyspraxia. Although both motor apraxia and dyspraxia patients have difficulties with the motor planning component of performing an action, it is important to note that there are some significant differences. One of the characteristics of apraxia that differentiates it is the fact that it is a disorder of “learned” movement while dyspraxia is a disorder of “new learning.” Simply put, patients with motor apraxia were previously able to perform the action whereas a person with dyspraxia has not performed it. In general, dyspraxia is a milder form that is most commonly associated with development while motor apraxia is most commonly a result of brain injury. This has significant implications in its treatment.
Types of Apraxia
There are many different types of motor apraxia that can affect an individual including:
• Ideomotor Apraxia: When a patient is unable to correctly imitate hand gestures.
• Ideational Apraxia: When a patient loses the ability to conceptualize, plan and execute complex sequences of motor actions, such as using everyday tools.
• Dressing Apraxia: When a patient cannot perform the complicated task of putting on clothes.
• Bucco-Facial Apraxia: When a patient is has difficulties with facial or lip movement
• Limb/ Manual Apraxia: When a patient has difficulties with arm or leg movements
• Speech Apraxia: When a patient has difficulties producing sounds and words with their mouths
• Constructional Apraxia: When a patient has difficulties with accurately copying drawings or building objects
Symptoms of Apraxia
The symptoms of apraxia vary with the type of apraxia a person has. This is because different regions of the brain may be affected with varying severity. A patient with a severe left side brain stroke will have different symptoms than a person with a mild right side brain stroke. Although there are not many common symptoms seen in all the types of motor apraxia, it is important to note that characterized by interrupted messaging, and are fairly apparent.
Treatment of Apraxia
The treatment of apraxia must be customized to treat the specific type of apraxia present in the patient. For example, a patient suffering from speech apraxia would benefit most from therapy with a speech pathologist, and thus, they obviously would not be referred to a physiotherapist. Likewise, the treatment of apraxia also focuses on helping the individual cope with the condition, as there is no cure that exists.
The ultimate goal in the treatment of apraxia revolves around compensation techniques, not medication. This is simply because damage in the brain cannot be repaired and the ultimate goal is to teach patients how to continue to live their lives. Some important interventions include:
• Strategy Training: When strategy training is used, patients are taught to use various compensation methods to compensate for their specific impairment. For example, a patient that is unable to produce words may be asked to draw or write out what they would like to say. Strategy training also incorporates errorless learning by forcing a patient to practice and repeat a task without any mistakes
• Sensory Stimulation: If a patient has limb apraxia, the medical professional may stimulate the patient’s limbs with deep pressure or sharp and soft touch.
• Proprioceptive Stimulation: In this form of stimulation, the patient slowly puts weight on their upper and lower limbs.
• Chaining (forward or backward): This technique involves breaking down a task into component parts and performing each step until the task is completed. The person typically has help from the therapist until they are able to perform each step unaided.
• Normal Movement Approaches: To help a patient perform normal movement patterns, a therapist may guide the patient’s body until they can do so themselves.
Apraxia prognosis is typically poor because there is no cure for brain damage yet. This is an important consideration because the main way medical professionals can affect apraxia prognosis is by controlling the extent of the damage. Specifically, they do this by trying to cure the underlying cause(s) of the brain damage and encouraging the patient to live a healthy lifestyle to prevent future damage. Due to the limitations of the known treatment of apraxia there is a heavy focus on compensatory methods to help the individual live as normal of a life as possible.
For any additional information on motor apraxia, please contact your local healthcare professional.