Apraxia - Clinical Causes, Diagnostic Features, and Therapeutic Support Strategies

What Is Apraxia Disorder?

It is a neuromotor disability where an individual cannot execute learned movements voluntarily. Even though the affected person is willing to do and has enough strength and capacity to understand the command, they cannot perform according to the plan. They suffer no weakness or sensory loss, but the individual simply cannot bring themselves to perform the activity. For this reason, people with apraxia have trouble meeting the activities of daily living. For instance, they find motor activities like buttoning up a shirt or tying the shoelace impossible to do. Generally, individuals affected with apraxia are dependent on others to a large extent throughout their life.

What Are the Causes of Apraxia?

For an apraxia-affected individual, the muscles, nerves, and functions are intact but cannot execute tasks the way they want. Depending upon which part of the brain is affected; there are different types of apraxia disorders:

1. Motor Apraxia - It is the inability to plan or perform any motor activity upon verbal command, although one can act spontaneously. For instance, the individual cannot open a door upon command but can open it spontaneously without thinking.

2. Ideomotor Apraxia - Inability to mimic the activity performed by another person on demonstration.

3. Conceptual Apraxia - Where the individual cannot even comprehend how a tool works or follow more than one task at a time.

4. Constructional Apraxia - It is the inability to draw shapes like circles or squares and design or copy even simple diagrams.

5. Ideational Apraxia - Cannot perform preplanned activities in a sequence such as dressing up or taking a bath.

6. Oculomotor Apraxia - Inability to move the eyeball in different directions.

7. Verbal Apraxia - Here, messages from the brain to the mouth are disrupted. Hence the individual cannot move their lips or tongue to the right place to say sounds correctly even though the muscles are not weak.

8. Buccofacial or Orofacial Apraxia - The individual cannot perform facial movements that are required to cough, whistle, wink, or make certain expressions.

9. Limb-Kinetic Apraxia - Where the person is unable to carry out activities that require precision and coordination with an arm or a leg.

What Are the Causes of Apraxia?

Apraxia is caused by lesions in the dominant hemisphere of the brain, usually the left one. Typically the premotor area and inferior parietal lobule or the corpus callosum may be affected. Although the nature of brain damage determines the severity of apraxia, it is maximum when a lesion is located in the dominant areas. Apraxia can be caused by lesions in other areas of the brain as well, including the non-dominant right hemisphere. In motor apraxia, the site of lesion in the brain may be the premotor area, inferior parietal lobule, or arcuate fasciculus of the dominant hemisphere.

• Ideomotor Apraxia - It is due to decreased blood flow to the brain’s dominant hemisphere, particularly the parietal and premotor areas. It is frequently seen in patients with degenerative nerve diseases.

• Callosal Apraxia - Also known as callosal disconnection syndrome or split-brain, happens due to a total disconnection between two halves of the brain. This usually results in apraxia confined to the left hand. As corpus callosum is the structure that transfers information between two hemispheres of the brain, memory and language abilities will suffer. It is usually due to blockage of blood supply to the corpus callosum.

• Ideational Apraxia - It is observed in patients with lesions in the dominant hemisphere and is often associated with aphasia.

• Constructional Apraxia - It is usually caused by lesions of the inferior non-dominant parietal lobe.

The lesions leading to brain damage can be due to:

1. Traumatic brain injury.

2. Tumors in the brain.

3. Stroke.

4. Neurodegenerative diseases such as Alzheimer’s disease, dementia, Parkinson’s disease, or Huntington's disease.

5. Hydrocephalus - Fluid accumulation inside the brain.

6. Apart from this, certain types of apraxia are genetically passed onto the next generation and acquired by birth.

How Is Apraxia Clinically Diagnosed?

It is essential to understand the underlying cause of apraxia. For this, the doctor will look into the medical history and match it up with the symptoms projected by the patient. Since many other neurological conditions show similar signs, they need to be ruled out as well.

Several tests are conducted to diagnose apraxia by evaluating:

• Communication abilities and efficiency.

• Functional abilities at performing specific tasks.

• Overall coordination of movement and activities.

• Level of comprehension and language tests.

What Are the Treatment Strategies for Apraxia?

Individuals suffering from apraxia require a multidisciplinary treatment approach. The primary goal is to treat the underlying cause. Medical management of stroke or neurological disease might improve apraxia symptoms. Additional supportive measures are physical and occupational therapy, where one practices repeated sequential movements to perform better. One can also learn other ways of expression instead of speech to express better.

What Is Childhood Apraxia of Speech?

This is a speech disorder connected to apraxia, where children find it hard to form words. It can be verbal apraxia or articulatory apraxia. The child can comprehend the language but cannot talk properly. They also find it difficult to pronounce some words and plan the sequence of words and phrases. In addition, they have difficulties giving the correct stress, rhythm, and inflection to terms.

How to Diagnose and Treat Childhood Apraxia of Speech?

First, a speech-language specialist should evaluate the affected individual to measure the level of speech disability. Follow this up with special education programs and daily speech therapy sessions with a specialist. There are specific tactics to improve apraxia of speech like:

• Making use of visual, auditory, and sensory cues such as sound records and mirrors to see and listen to how sounds are produced.

• Performing exercises to make the muscles around the mouth stronger.

• Mastering sign language to compensate for speech if it is challenging to learn.

Conclusion:

Apraxia is a disorder with multiple levels of disabilities. Improvement of symptoms varies from individual to individual. Some of them suffering from acquired apraxia of speech have shown spontaneous recovery from symptoms with time. However, if adequate support and encouragement are provided at home, society, work, and school, people with apraxia can also improve their quality of life. Keep in mind that it all starts with proper clinical diagnosis by a qualified medical professional.