Brain injury and apraxia are interconnected conditions that significantly impact an individual's ability to perform everyday tasks. Understanding the relationship between brain injury and apraxia requires a comprehensive exploration of their definitions, causes, types, symptoms, impacts, treatments, and future directions. This article tackles these aspects to provide a thorough understanding of how brain injury can lead to apraxia and the implications for affected individuals.1,2
Introduction
What Is brain injury?
Brain injury is defined as any damage to the brain that impairs its normal function. This can result from various factors such as traumatic events (e.g., falls, car accidents), strokes, neurodegenerative diseases, infections, and tumours. Brain injuries can range from mild concussions to severe traumatic brain injuries (TBI), each varying in its impact on cognitive and physical abilities.2
What is apraxia?
Apraxia is a motor disorder characterised by the inability to perform learned movements or gestures, even though the desire and physical ability to perform the movements are present. There are more than 30 different types of apraxia, which include ideomotor apraxia, ideational apraxia, limb-kinetic apraxia, apraxia of speech and buccofacial (orofacial) apraxia, all subtypes each affecting specific types of movements and actions.1,3
Causes & mechanisms of apraxia
Causes of brain injury leading to apraxia
Brain injuries that lead to apraxia can stem from several sources:
- TBI: Often caused by external forces such as falls, vehicle accidents, and sports injuries, TBI can result in widespread or localised brain damage, potentially leading to apraxia, accounting for 19-45 % of all cases.
- Stroke: A stroke, particularly one affecting the left hemisphere, can damage brain regions responsible for planning and executing movements, causing apraxia, accounting for 50% of all cases.
- Neurodegenerative Diseases: Conditions such as Alzheimer's disease and Parkinson's disease can lead to progressive brain damage, resulting in apraxia as cognitive and motor functions decline, accounting for 90% of cases.
- Infections and Tumours: Brain infections (e.g. encephalitis) and tumours can disrupt normal brain function and pathways, leading to motor deficits including apraxia.1,4
Neurological mechanisms
The neurological mechanisms underlying apraxia involve the disruption of brain regions and pathways essential for motor planning and execution. Key areas include:
- Frontal Lobe: This houses the motor cortex which is responsible for planning and initiating movements. Damage here can result in difficulties in organising and executing movements.
- Parietal Lobe: Involved in spatial awareness and coordination. Damage can lead to problems with sequencing movements and using objects correctly.
- Corticospinal Tract: Pathways that convey motor commands from the brain to the spinal cord. Disruption can affect the transmission of motor commands.1,5
Types of apraxia related to brain injury
Ideomotor apraxia
Ideomotor apraxia is characterised by difficulty in performing or imitating learned movements on command, even though the individual can understand the task and has the physical capability to perform it. For example, a person might struggle to wave goodbye or use a hammer.
Ideational apraxia
Ideational apraxia involves difficulty in conceptualising and sequencing multi-step tasks. Individuals with this type may struggle with tasks such as making coffee, where multiple steps need to be performed in a specific order. They may misplace steps or use objects incorrectly.
Apraxia of speech (AOS)
Apraxia of speech (AOS) is a motor speech disorder in which people struggle to organise and coordinate the movements required for speech. Despite knowing what they want to say and having the physical ability to speak, they struggle to form words correctly and consistently.
Other forms
- Limb-Kinetic Apraxia: Difficulty in making precise, coordinated movements with a limb. This can affect tasks requiring fine motor skills.
- Buccofacial (Orofacial) Apraxia: Involves difficulty in performing movements with the face and mouth, such as whistling, licking lips, or speaking clearly.1,5
Diagnosis
Diagnosing apraxia involves a combination of clinical assessments and neuroimaging techniques:
- Clinical Assessments: Standardised tests and observational methods are used to evaluate motor skills, task performance, and the ability to follow commands.
- Neuroimaging: Techniques like MRI and CT scans help identify brain damage and pinpoint areas involved in the motor deficits observed.1,4
Impact on daily life
Apraxia significantly affects an individual's ability to perform daily activities, leading to frustration and a decreased quality of life. Simple tasks such as dressing, cooking, or using household items become challenging, affecting independence.1,5
Additionally, the professional and social impacts of apraxia are profound. Individuals may face difficulties maintaining employment, leading to financial strain. Social interactions can be affected as communication and physical gestures become problematic, leading to social isolation and emotional distress.1
Treatment & management
Rehabilitation approaches
Rehabilitation for apraxia typically involves:
- Occupational Therapy: Focuses on improving daily living skills through practice and adaptation techniques.
- Physical Therapy: Aims to enhance motor skills, coordination, and movement patterns.
- Speech-Language Therapy: Helps address communication issues, particularly in cases of buccofacial apraxia.
Therapeutic techniques
Specific therapeutic techniques include:
- Task-Specific Training: Practising specific tasks repeatedly to improve execution.
- Assistive Devices: Use of tools and devices to aid in performing tasks, such as adaptive utensils for eating.
Emerging treatments
Emerging treatments offer hope for improved outcomes:
- Neuromodulation: Techniques like transcranial magnetic stimulation (TMS) show promising results in enhancing brain plasticity and motor function.
- Pharmacological Interventions: Medications targeting neurotransmitter systems may aid in improving motor functions and task execution.1,4
Research & future directions
Current research focuses on understanding brain plasticity and recovery mechanisms. Studies investigate how the brain reorganises itself following injury and the potential for rehabilitation to enhance this process. Advances in neuroimaging give insight into the structural and functional differences in the brain linked to apraxia.
Future developments may include innovative therapies and improved diagnostic techniques. Research into brain-computer interfaces and virtual reality-based rehabilitation offers new avenues for enhancing motor recovery. Improved diagnostic tools could lead to earlier and more accurate identification of apraxia, enabling timely intervention.1
FAQs
Is apraxia curable?
The short answer is that there is no cure but occupational therapy, speech therapy and physical therapy are all effective in improving impairments and making the condition easier to manage and live with. Addressing the underlying cause of apraxia remains the most important factor.1
How do you know you have apraxia?
To determine if you have apraxia, observe for key symptoms such as difficulty performing learned movements or gestures despite having the desire and physical ability to do so. Common indicators include struggling to perform simple tasks like waving goodbye, making coffee, or speaking clearly, and difficulty with sequencing and coordination of movements.6
To be sure of apraxia, diagnosis typically involves clinical assessments by healthcare professionals, including standardised tests and possibly neuroimaging to identify any brain damage affecting motor function. However, in the case of apraxia caused by neurodegenerative disorders, unfortunately, the individual may be unaware of this inability to perform certain tasks.1
Is it apraxia or aphasia?
Aphasia and apraxia are both neurological conditions but affect different aspects of communication. Aphasia primarily impacts language abilities, including speaking, understanding, reading, and writing, and is often caused by damage to the brain's language centres, typically due to a stroke or brain injury. Apraxia, on the other hand, is a motor disorder that affects the ability to plan and execute movements necessary for speech or other tasks, despite having the physical capacity to perform them. Thus, while aphasia is a language disorder, apraxia is a motor planning disorder.4
Summary
Brain injury and apraxia are interconnected, with brain damage disrupting motor planning and execution pathways. Understanding the types, symptoms, impacts, and treatments of apraxia is crucial for effective management and improving the quality of life for affected individuals. Continued research and awareness are essential for developing innovative treatments and providing support for individuals with apraxia. By enhancing our understanding and interventions, we can help those affected regain independence and improve their overall well-being.
References
- Gowda SN, Kolton Schneider L. Apraxia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Jun 15]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK585110/.
- Traumatic Brain Injury (TBI) | National Institute of Neurological Disorders and Stroke [Internet]. [cited 2024 Jun 15]. Available from: https://www.ninds.nih.gov/health-information/disorders/traumatic-brain-injury-tbi.
- Baumard J, Le Gall D. The challenge of apraxia: Toward an operational definition? Cortex [Internet]. 2021 [cited 2024 Jun 15]; 141:66–80. Available from: https://www.sciencedirect.com/science/article/pii/S0010945221001428.
- Clinical Neuroepidemiology of Acute and Chronic Disorders [Internet]. Elsevier; 2023 [cited 2024 Jun 15]. Available from: https://linkinghub.elsevier.com/retrieve/pii/C20210008373.
- Neurobiology of Brain Disorders [Internet]. Elsevier; 2015 [cited 2024 Jun 15]. Available from: https://linkinghub.elsevier.com/retrieve/pii/C20090639180.
- Rausch SL. Apraxia: Symptoms, Causes, Tests, Treatments. WebMD [Internet]. [cited 2024 Jun 15]. Available from: https://www.webmd.com/brain/apraxia-symptoms-causes-tests-treatments.