Discover the symptoms, causes, and management of apraxia, a motor disorder, on Meri Sehat.

Apraxia

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Syed Intisar Hussain

Overview

Apraxia is a neurological condition marked by an inability to carry out learned (read: familiar) actions when instructed, despite understanding the instruction and being eager to perform. In other words, the ability to act is there, as well as the desire, but the person is unable to act. 
Apraxia is a neurological disorder that is not well understood. Despite having normal muscles, those who have the condition find it difficult or impossible to perform some motor functions. Patients with apraxia are unable to utilize tools or carry out simple tasks like buttoning shirts or tying shoelaces. Daily life necessities become challenging. 
&nbsp;

Apraxia means the complete loss of the ability to do something , while dyspraxia indicates a partial loss of ability to do something with accuracy.&nbsp;

According to estimates, childhood apraxia of speech (CAS) affects 1-2 children out of every 1,000. According to estimates, the ratio is 2-3:1 higher in male children than in female ones. There is a higher chance of concurrent language, reading, and/or spelling difficulties in children with CAS, according to research<a href="#accordion">[7]</a>.

CAS or its traits are reportedly more common in some diseases, including galactosemia, fragile X syndrome, and velocardiofacial syndrome. Children with autism spectrum disorder (ASD) do not have a higher prevalence of CAS even though simultaneous speech delay and speech problems are more common in ASD patients<a href="#accordion">[7]</a>. 
&nbsp;

Different types of apraxia can affect the body in different ways, such as: 
&nbsp;

<ul>
	<li>Limb-Kinetic Apraxia &ndash; Inability to use a leg, finger, or arm for coordinated precise movements. They may have carried out said task in the past but may be unable to carry it out again. 
	&nbsp;</li>
	<li>Ideomotor Apraxia &ndash; Inability to follow verbal instructions or copy a movement from someone else. 
	&nbsp;</li>
	<li>Conceptual Apraxia &ndash; Inability to perform tasks involving more than a single step. 
	&nbsp;</li>
	<li>Ideational Apraxia &ndash; Inability to plan a specific movement. It causes difficulty to follow a sequence of movements such as bathing or getting dressed. 
	&nbsp;</li>
	<li>Buccofacial Apraxia &ndash; Also known as facial-oral apraxia, it is associated with the inability to make movements with the lips and face on command. 
	&nbsp;</li>
	<li>Constructional Apraxia &ndash; Inability to draw, copy, or construct basic figures or diagrams. 
	&nbsp;</li>
	<li>Oculomotor Apraxia &ndash; It affects the eyes. It is associated with difficulty in making eye movements on command. 
	&nbsp;</li>
	<li>Verbal Apraxia &ndash; Also known as apraxia of speech, it makes it difficult for people with verbal or oral apraxia to make the movements required for speech. They struggle to make sounds and comprehend speech rhythms. There are two types of verbal apraxia, including childhood apraxia of speech and acquired apraxia of speech. 
	&nbsp;</li>
</ul>

Signs and Symptoms

A person&#39;s inability to move, in the absence of any physical paralysis, is the main sign of apraxia. The inability to perform specified motions on demand is a defining feature of particular forms of apraxia. For instance, a person with buccofacial apraxia is unable to cough, whistle, lick their lips, or wink when requested. An individual with constructional apraxia is unable to duplicate straightforward patterns or copy straightforward drawings. 
&nbsp;

Although the person can understand the commands, they cannot carry them out. Movement is frequently awkward, uncontrolled, and unsuitable. Also, occasionally, it&rsquo;s unintentional movement. Besides, sometimes a person with apraxia also loses their capacity to understand or use language, a condition called aphasia. 
&nbsp;

Some common symptoms of apraxia include:

<ul>
	<li>Difficulty initiating or sequencing movements, especially complex or multi-step actions</li>
</ul>

<ul>
	<li>Inability to perform learned or familiar movements or gestures, such as brushing teeth or waving goodbye</li>
</ul>

<ul>
	<li>Awkward or incorrect movements even when the individual understands the task and has the physical ability to complete it</li>
</ul>

<ul>
	<li>Difficulty imitating or copying movements even when watching them being performed</li>
</ul>

<ul>
	<li>Inability to use tools or objects correctly, such as using a fork or opening a jar</li>
	<li>Difficulty with nonverbal communication, such as making eye contact, facial expressions, or body language</li>
</ul>

<ul>
	<li>Frustration or <a href="https://merisehat.pk/disease/anxiety">anxiety </a>when attempting to perform difficult or impossible actions due to the condition 
	&nbsp;</li>
</ul>

NOTE: Apraxia can be present alone or in combination with other conditions, such as aphasia, a language disorder that affects communication. If you or someone you know is experiencing symptoms of apraxia, it&#39;s important to seek medical evaluation to determine the underlying cause and appropriate treatment. 
&nbsp;

<h5>Difference Between Apraxia Of Speech And Aphasia</h5>

Apraxia is a communication disorder that is often confused with aphasia, another communication disorder. The two may or may not occur concurrently.<a href="#accordion">[8]</a> 
&nbsp;

While both conditions may make it difficult for a person to express themselves with words, there are distinct differences between them. Aphasia is a problem with a person&#39;s ability to understand or use words, which can make it hard for them to speak, read, or write. Apraxia, on the other hand, refers to the difficulty a person has initiating and performing the movements needed to make a speech despite having no weakness in the necessary muscles. It does not describe a problem with language comprehension. 
&nbsp;

Causes

Apraxia is usually caused due to damage to the parietal lobes or to the neuronal pathways that link these lobes to other areas of the brain, such as the frontal&nbsp;or temporal lobes. These areas influence memory and learned sequences of movement and apraxia patients are unable&nbsp;to access this information. 
&nbsp;

Any disease or head injury that affects the brain can cause apraxia. This includes:

<ul>
	<li>Trauma to the head</li>
	<li>Stroke</li>
	<li>Dementia</li>
	<li>Corticobasal ganglionic degeneration</li>
	<li>Tumors</li>
	<li>Hydrocephalus<a href="#accordion">[3]</a></li>
</ul>

Apraxia is more prevalent among the elderly due to the higher prevalence of neurological illnesses, such as dementia and stroke at that age. Apraxia brought on by post-stroke edema may get better in a couple of weeks. 
&nbsp;

Apraxia can also be a genetic&nbsp;condition. For instance, an infant who presents with apraxia at birth may have issues with the central nervous system. 
&nbsp;

Diagnosis

Doctors ask the patient to perform or mimic commonly taught skills, such as using a toothbrush, scissors, or screwdriver, to identify apraxia. They&rsquo;ll question the patient&rsquo;s family or caretakers about how well they can write, use utensils when eating, and perform other daily tasks.

Additionally, doctors ask patients to follow particular instructions, such as asking them to wave goodbye or showing them how to use a hammer, to gauge how effectively their brains can receive the instruction.

They&rsquo;ll also perform a physical examination to ascertain if symptoms are brought on by other similar conditions, like muscle weakness or a problem with the muscles or joints. 
&nbsp;

Furthermore, doctors may order both language and physical tests to assess:

<ul>
	<li>Verbal and non-verbal communication</li>
	<li>How people function and participate in certain activities</li>
	<li>Coordination</li>
	<li>Listening and hearing abilities 
	&nbsp;</li>
</ul>

For instance, neuropsychological testing or specific standardized examinations of brain function may be performed. The results of neuropsychological testing reveal information on the functioning of various brain regions. The doctor will ask the patients questions that will help assess a patient&#39;s intelligence, executive function (the capacity to plan, organize, and initiate actions), attention, memory, language, motivation, mood and emotion, quality of life, and personality. 
&nbsp;

To identify the origin of the brain damage, the following tests are administered<a href="#accordion">[3]</a>:

<ul>
	<li>Computed tomography or magnetic resonance imaging</li>
	<li>Electroencephalogram may be used to see if epilepsy caused apraxia</li>
	<li>Spinal tap to check for inflammation or an infection affecting the brain 
	&nbsp;</li>
</ul>

Treatment

Apraxia does not have a specific treatment.

Some apraxia patients may benefit from physical and occupational treatment. However, the primary functions of these treatments are to provide a safer atmosphere and to offer tools that enhance human performance.

Verbal apraxic individuals can benefit from speech therapy by repeatedly practicing sound patterns. If verbal apraxia is severe, the speech therapist and/or occupational therapist can teach them how to communicate by using a keyboard and message display on an electronic device, a letter or picture board, or both. 
&nbsp;

Possible complications of apraxia include: 
&nbsp;

<ul>
	<li>Low self-esteem</li>
	<li>Learning difficulties</li>
	<li>Social problems</li>
	<li>Reading and writing difficulties along with language delay</li>
	<li>Behavior issues 
	&nbsp;</li>
</ul>

The risk factors of apraxia are: 
&nbsp;

<ul>
	<li>Genetic factors</li>
	<li>Brain malformation or injury</li>
	<li>Developmental disorders</li>
	<li>Premature birth</li>
	<li>Environmental exposure of the mother during pregnancy 
	&nbsp;</li>
</ul>

These factors increase the risk of apraxia. However, not all children with these risk factors will develop apraxia. Additionally, many children with apraxia do not have any identifiable risk factors. 
&nbsp;

There is no known way to prevent apraxia. However, the following measures may help reduce the risks: 
&nbsp;

<ul>
	<li>Taking measures to reduce the risk of stroke can prevent brain injury, thereby, reducing the chances of apraxia</li>
	<li>Early intervention can help prevent further delay</li>
	<li>Regular prenatal checkups 
	&nbsp;</li>
</ul>

<ul>
	<li>A survey was conducted to determine which treatment approaches were preferred for children with childhood apraxia of speech (CAS). The results showed that 57.7% of participants voted for oral motor exercises as the preferred treatment approach. The experts preferred phonologically-based treatments and integrated phonological awareness, while less-experienced participants were more interested in PROMPT. Additionally, 70.8% of participants believed that children with CAS make very slow progress, and 21.9% determined that speech problems persist throughout school years for them<a href="#accordion">[5]</a>. 
	&nbsp;</li>
	<li>A survey was conducted by Iranian speech-language pathologists&nbsp; to identify the core symptoms of CAS and co-occurring problems. 260 questionnaires were filled out by anonymous participants. The top nine speech characteristics of CAS with 75.6% agreement were identified: inconsistency (86.9%), consonant sequencing problems (75%), low intelligibility (75%), groping (72.7%), slow diadochokinetic (72.3%), difficulty with multisyllabic words (62.7%), articulatory configuration problems (66.2%), suprasegmental disturbances (56.2%), and metathesis (53.5%). The respondents&#39; agreement was consistent with the established diagnostic criteria and models. Fine motor deficits and language impairment were reported as the most common co-occurring problems of CAS<a href="#accordion">[6]</a>. 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Apraxia is a neurological condition marked by an inability to carry out learned (read: familiar) actions when instructed, despite understanding the instruction and being eager to perform.</li>
	<li>Patients with apraxia are unable to utilize tools or carry out simple tasks like buttoning shirts or tying shoelaces.</li>
	<li>Verbal apraxia, also known as apraxia of speech, makes it difficult for people with verbal or oral apraxia to make the movements required for speech.</li>
	<li>Apraxia is usually caused due to damage to the parietal lobes or to the neuronal pathways that link these lobes to other areas of the brain, such as the frontal&nbsp;or temporal lobes.</li>
	<li>The results of neuropsychological testing reveal information on the functioning of various brain regions.</li>
	<li>Apraxia is more prevalent among the elderly due to the higher prevalence of neurological illnesses, such as dementia and stroke at that age.</li>
	<li>Apraxia can also be a genetic&nbsp;condition.</li>
	<li>Verbal apraxic individuals can benefit from speech therapy by repeatedly practicing sound patterns. 
	&nbsp;</li>
</ul>

[1] Apraxia: Definition, causes, symptoms, and treatment. Medical News Today.

[2] Apraxia. National Organization for Rare Disorders.

[3] Apraxia: Medlineplus medical encyclopedia. MedlinePlus.

[4] Huang J. Apraxia - brain, spinal cord, and nerve disorders. MSD Manual Consumer Version.

[5] Imani-Shakibayi M, Zarifian T, Zanjari N. Assessment and treatment of childhood apraxia of speech: An inquiry into knowledge and experience of speech-language pathologists. Iranian Rehabilitation Journal.

[6] Shakibayi MI, Zarifian T, Zanjari N. Speech characteristics of childhood apraxia of speech: A survey research. International Journal of Pediatric Otorhinolaryngology. 2019;126:109609. doi:10.1016/j.ijporl.2019.109609.