Published Date: January 1, 2023


Apraxia


Authors: Supreeth N. Gowda, Lynne Kolton Schneider


2023 Aug 14. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–.

ABSTRACT

Apraxia covers a broad spectrum of neurological conditions characterized by an inability to perform previously familiar tasks or learned acts, which cannot be explained by motor or sensory weakness, deficits in comprehension, or incoordination. Apraxia is a diagnosis of exclusion and was differentiated into three types by Liepmann: limb-kinetic, ideomotor, and ideational. Currently, apraxias can be classified based on task-specific or general actions and the anatomical location of the lesion in the brain.

General

  1. Ideomotor (constitutional) - most common, decreased motor skill, wong motions and joints used

  2. Ideational - conceptualization and use of tools/series of actions

  3. Conceptual - loss of tool knowledge

  4. Limb-Kinetic (melokinetic) - precise movements/ hands and fingers

  5. Dissociation and conduction apraxia- modality-specific defects in skills

Task-Specific

  1. Gait

  2. Speech

  3. Specific constructional: draw, construct, copy

  4. Apraxia agnosia

The term apraxia can literally be defined as "without action." (Other terms that might be used adjacently are praxis meaning action, and dyspraxia, meaning partial action.) Apraxia's onset can either be childhood apraxia or acquired. Acquired apraxia can be seen and is not limited to cerebrovascular accidents (CVA), traumatic brain injury (TBI), brain tumors, schizophrenia, or neurodegenerative disorders. The basis for understanding the pathogenesis of apraxia comes from various lesional studies.

Carrying out an action (praxis) involves the activation, inhibition, or both, of different regions and neural networks. The type of apraxia can depend on the neural network involved. Diagnosis of apraxia is through careful history, neurological examination, and apraxia-specific testing with support from radiological and laboratory reports. However, there is little consensus on best practices in assessing apraxia.

Management mainly involves the treatment of underlying causes along with physical, occupational, or task-specific therapies and counseling. Long-term effects and prognosis depend on the type of apraxia and its effect on the patient's activities of daily living (ADL). Complications can vary from acalculia, agraphia, aphasia, or confusion to social anxiety and low-self esteem. Patients with apraxia may require long-term assisted nursing care.

PMID: 36256757