Living With Apraxia: Challenges And Coping Strategies

  • Angus MacfarlaneMSc, Public Health, London School of Hygiene and Tropical Medicine, U. of London

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Overview 

Apraxia is a complex neurological disorder characterised by an individual’s inability to perform specific voluntary movements, despite having the physical capability and desire to do so.1 This condition is caused by damage to the brain's motor planning and programming areas, particularly in the left hemisphere.1 Such damage can result from a stroke, brain injury, or progressive neurological disorder.1

Living with apraxia creates numerous physical and mental challenges for those who battle the disorder on a daily basis. This article will explore these challenges, examine the different forms of apraxia, and discuss how the disorder may present in individuals. Additionally, it will offer coping strategies aimed at promoting independence, confidence, and overall well-being for those living with the condition.

Types of apraxia 

Apraxia can manifest in several different ways. Some of the major types include:

Ideomotor apraxia

The person retains the idea of what they want to do but cannot translate that concept into the correct motor actions.2 For example, a person might understand the concept of waving goodbye, but when asked to demonstrate, they might make an incorrect gesture, such as patting their head instead.

Ideational apraxia

This involves losing the mental concept of how to perform a previously known skill.3 For example, a person might forget the sequence of steps needed to brush their teeth. They may pick up the toothbrush but then be unsure of what to do next, despite having brushed their teeth daily for years.

Limb-kinetic apraxia

This involves the loss of fine motor skills in a limb, making precise movements difficult.4 For example, a person might struggle to button their shirt or tie their shoelaces, even though they understand the concept and intend to perform these actions.

Conceptual apraxia

This involves the loss of the ability to understand the purpose or use of tools and objects.5 For example, a person might pick up a hammer but not know what it's for or how to use it. They might try to use it inappropriately, such as attempting to write with it as if it were a pen.

Common challenges of living with apraxia

Living with apraxia presents numerous challenges across various aspects of a person's life. Understanding these challenges is crucial, as it forms the basis for developing effective coping strategies for the disorder.

Daily tasks

Apraxia can significantly disrupt daily routines, making once simple, automatic tasks challenging. For example, individuals may struggle with daily self-care activities like dressing, brushing their teeth, or preparing and eating meals.

Using normal household appliances and organising personal belongings are other examples of tasks that can become challenging for individuals with apraxia. When unable to perform these tasks properly, sufferers often have to rely more on others to help them out. Additionally, this aspect of the condition can lead to tasks taking longer to complete, leading to feelings of frustration.

Communication 

Another challenging aspect of apraxia is that it can have a significant impact on a person's ability to communicate.6 Sufferers often struggle to articulate their words and produce the sounds needed for others to understand them as they speak.

These communication difficulties make it difficult for those with apraxia to express their thoughts, needs, and emotions on a daily basis. As with daily routine tasks, inadequate communication skills often force individuals with apraxia to rely heavily on others to understand their needs, express themselves, and advocate for them. These difficulties also create a number of hurdles in work and educational settings, which will be covered later in this article. 

Safety

Apraxia can raise significant safety concerns in daily life due to difficulties in motor planning and coordination. For instance, individuals may struggle with tasks such as handling sharp objects, using hot surfaces, or operating machinery, increasing the risk of accidents.

Impairment in spatial awareness also makes it challenging to judge distances or navigate spaces, leading to a higher likelihood of tripping, bumping into objects, or misjudging steps.7 These safety risks often necessitate increased vigilance and, sometimes, supervision to ensure the well-being of those affected and to prevent accidents.

Cognitive challenges

In cases of apraxia, the brain is forced to work overtime to manage even basic tasks, leading to quicker mental fatigue. This constant mental strain also depletes cognitive resources, leaving fewer available for other processes such as memory, attention, and problem-solving.7

The increased cognitive load may also impair an individual’s ability to process new information, making it more difficult to learn and adapt to new situations. As the brain struggles to compensate for these deficits, individuals may find themselves more easily overwhelmed by complex tasks. 

Professional settings

In the workplace, apraxia poses unique challenges. For example, employees may struggle with tasks requiring fine motor skills, such as typing, writing, or handling tools. Communication difficulties, especially in cases of apraxia of speech, can hinder a person's ability to interact with colleagues or superiors, affecting their overall job performance.

The increased cognitive load that individuals with apraxia experience can also impact their concentration and multitasking abilities, potentially reducing productivity. As a result, those suffering with apraxia often require workplace adjustments to be made.8

Educational settings

Students with apraxia face significant hurdles in educational environments. Note-taking can be slow or illegible due to motor skill issues. Participating in class discussions and speaking with teachers and other students may also be challenging due to apraxia of speech. As a result, students with apraxia often require special accommodations in schools.9

Emotional impact

Living with apraxia often brings significant emotional challenges. Individuals frequently experience feelings of frustration and anxiety as they struggle with tasks that were once simple, natural, and routine. The loss of independence can also lead to feelings of helplessness and depression.7 As mentioned in the cognitive challenges section, the constant effort required in daily life can result in emotional exhaustion and mood swings.

Coping strategies 

Apraxia can present significant challenges, but effective coping strategies can help improve the quality of life for those affected. 

Physical therapy 

Physical therapy can help improve motor skills in individuals with apraxia by promoting more efficient coordination between the brain and muscles.10 Regular practice of specific movements or tasks, such as buttoning a shirt or using utensils, allows the brain and body to gradually learn to work together more effectively. Over time, this repeated practice can make it easier to perform these actions in daily life.

Communication strategies

Visual aids, such as picture boards or gestures, can be used as alternatives to speech and help individuals with apraxia communicate. Writing notes is another option that can be helpful. Additionally, assistive communication devices, such as speech-generating apps or text-to-speech software, can empower individuals with apraxia to communicate more effectively.11

Emotional well-being

Managing stress and maintaining a positive outlook are crucial for enhancing the overall quality of life for individuals with apraxia. Activities such as mindfulness and meditation can be particularly effective in reducing stress and anxiety. In addition to these mental health practices, regular physical exercise plays a key role in managing stress, as it can help alleviate the frustration that often accompanies apraxia.

Engaging in social activities and building a support network can also provide emotional reinforcement. Connecting with others who understand their struggles can reduce feelings of isolation and offer practical coping strategies. 

Environmental modifications

Making adjustments to one's environment can help reduce the demands on motor skills. For example, using ergonomic utensils, grab bars, or adapted tools can make daily tasks more manageable. Additionally, rearranging furniture or removing clutter can create a safer and more accessible living space, minimising the risk of tripping or falling associated with the disorder. 

Professional guidance

Seeking guidance from professionals, such as therapists or support workers, can be invaluable for individuals with apraxia as they navigate various challenges in their lives. Vocational support workers, for example, can assist in identifying job opportunities, while educational support workers can ensure that students with apraxia receive the necessary accommodations and resources to succeed in school.

Therapists, including occupational and speech therapists, can provide tailored strategies and insights to help individuals manage both the cognitive and emotional aspects of the disorder. 

Summary 

Living with apraxia presents numerous physical and emotional challenges that significantly impact daily life. Individuals with the disorder often struggle with simple tasks, communication, safety, and professional or educational responsibilities.

These challenges can lead to frustration, reduced independence, and emotional distress. Despite these difficulties, various coping strategies can improve the quality of life for people with apraxia. Physical therapy can enhance motor skills, while assistive communication devices and environmental modifications can support communication and daily functioning, respectively.

Seeking professional guidance can also provide valuable support in managing the disorder. Overall, while apraxia presents significant hurdles, a combination of practical strategies and emotional resilience can help individuals manage the disorder and maintain a sense of autonomy and well-being.

References

  1. Baumard J, Le Gall D. The challenge of apraxia: Toward an operational definition? Cortex [Internet]. 2021 [cited 2024 Aug 13]; 141:66–80. Available from: https://www.sciencedirect.com/science/article/pii/S0010945221001428.
  2. Wheaton LA, Hallett M. Ideomotor apraxia: a review. J Neurol Sci. 2007; 260(1–2):1–10.
  3. [Internet]. Ideomotor Dyspraxia and Ideational Dyspraxia – Scottish Acquired Brain Injury Network; [cited 2024 Aug 13]. Available from: https://www.acquiredbraininjury-education.scot.nhs.uk/impact-of-abi/visual-and-perceptual-impairments/dyspraxia/ideomotor-dyspraxia-and-ideational-dyspraxia/.
  4. Park JE. Apraxia: Review and Update. J Clin Neurol [Internet]. 2017 [cited 2024 Aug 13]; 13(4):317–24. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653618/
  5. Apraxia - Apraxia. MSD Manual Professional Edition [Internet]. [cited 2024 Aug 14]. Available from: https://www.msdmanuals.com/en-gb/professional/neurologic-disorders/function-and-dysfunction-of-the-cerebral-lobes/apraxia
  6. What Is Apraxia of Speech? | NIDCD [Internet]. 2017 [cited 2024 Aug 14]. Available from: https://www.nidcd.nih.gov/health/apraxia-speech.
  7. Gowda SN, Kolton Schneider L. Apraxia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Aug 15]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK585110/
  8. Adjustments | University of St Andrews [Internet]. [cited 2024 Aug 15]. Available from: https://www.st-andrews.ac.uk/hr/edi/disability/dyspraxia/adjustments/.
  9. Apraxia of Speech Factsheet (for Schools) (for Parents) [Internet]. [cited 2024 Aug 16]. Available from: https://kidshealth.org/en/parents/apraxia-factsheet.html
  10. Apraxia - Conditions - Neurological - What We Treat - Physio.co.uk [Internet]. [cited 2024 Aug 16]. Available from: https://www.physio.co.uk/what-we-treat/neurological/conditions/apraxia.php#:~:text=Physiotherapy%20treatment%20will%20depend%20on,in%20order%20to%20improve%20walking
  11. Lingraphica [Internet]. AAC Devices For Apraxia; [cited 2024 Aug 16]. Available from: https://lingraphica.com/speech-generating-devices/

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Angus Macfarlane

MSc, Public Health, London School of Hygiene and Tropical Medicine, U. of London

Angus is a recent biology graduate now pursuing an MSc in Public Health at the London School of Hygiene and Tropical Medicine. With a strong background in biological sciences, he is driven by a passion for tackling global health issues through evidence-based research and effective health communication. His academic interests include epidemiology, disease prevention, and health policy. As a new writer, Angus enjoys breaking down complex health topics to make them accessible and engaging for readers.

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