Apraxia

Apraxia is a neurological disorder characterized by the loss of the ability to carry out purposeful, learned and familiar movements, despite having the physical capacity (muscle tone and coordination) and the desire to carry them out. That is, there is a dissociation between the idea (the patient knows what he wants to do) and motor execution (he lacks action control).

Patients affected by this disorder have marked difficulty performing a movement when asked to do so out of context, but can easily do so spontaneously in a natural situation (John P.J.Pinel 2007).

It differs from dyspraxias in that these are due to an error in the internal construction of movement sequences to reach a specific and intentional act, and not to the loss of a previously performed action learned as would be the case of apraxias.

Etiology

Ideomotor apraxia is almost always caused by lesions of the dominant cerebral hemisphere (usually the left) for speech, in addition to the fact that these patients often present concomitantly with aphasia, especially Broca's area. It can also be caused by an injury to the corpus callosum.

Classification

There are several types of apraxia, depending on their relationship with the action or movement to be performed, they are classified as:

• Apraxia ideacional, which manifests itself as a loss in the ability to mentally formulate and verbally express the sequence of the different processes related to action. So, by asking the person (Semiology) to present this type of apraxia, to communicate aloud the sequence of movements to, for example, carry the spoon to the mouth, this subject does not succeed in accomplishing the task.
• Constructive apraxia, in which building disorders in space prevents them from correctly writing and reproducing simple drawings,
• Ideomotora, in which the individual successfully plans motor activities without being able to expose the corresponding expressions
• Bucolingual, bucofacial and/or bucolinguofacial, of importance in fonoauditive apraxias, such as the movement of the tongue, lips, etc.
• Others: oral, laryngea, speech, articulatory, etc.

Diagnosis

It is preferable to evaluate these disorders sequentially in order to perceive the variations of individual intensity in the person. Various methods have been devised such as the test of connecting numbers and letters, sometimes alternately, drawing known figures, such as stars or consecutive circles, imitation of mimicry and gestures, the use of imaginary objects (combing one's hair, brushing one's teeth, etc.)., cutting bread, etc.), mouth movements (blowing out an imaginary candle, coughing, etc.), among others.

Treatment

Generally, treatment for individuals with apraxia includes neuropsychology, speech therapy, occupational therapy, physiotherapy (within neurological physiotherapy, apraxia would be one of the cases in which the application of the Bobath Concept would be indicated), and intravenous immunoglobulin (IVIG). If the apraxia is a symptom of another disorder (usually neurological), it should be treated first.