Overview

Imagine simple daily tasks, such as brushing your hair or dressing yourself, feeling like an impossible puzzle – this is what it is like for someone with Apraxia.  Apraxia is a neurological disorder that affects motor cognition, planning and performance of tasks, without motor function or comprehension being damaged.¹ Subsequently, Apraxia negatively impacts the quality of life.² However, despite the struggles and overwhelming feelings of completing everyday tasks, there are many different interventions, implemented by occupational therapists, that can help to improve sufferers’ lives.³ This is one of the reasons why occupational therapy (OT) is essential to those with Apraxia, as it offers personalised solutions to help regain control and independence.⁴ 

This article will explore in more detail the symptoms, types and causes of Apraxia, as well as the role OT has in treating it. Additionally, specific Apraxia interventions and therapies will be reviewed. Read on to discover how these techniques can transform lives.

What is Apraxia?

Apraxia can be defined as the inability to perform praxis movements, which include skilled or learned movements, considered essential for day-to-day tasks.² Therefore, those with Apraxia are unable to perform volitional movements, which are intended movements, executed as a result of a decision or a choice.⁵

Apraxia causes patients to be unable to perform learned movements on command - even though they understand the command and there is a willingness to perform the movement. This is due to movement and tasks being performed through motor planning, in which the brain plans the action and then carries it out (i.e. before waving goodbye, a signal is sent to your brain, and subsequently, your hand starts moving). These actions are often so natural and simple, that we are oblivious to the planning process, as this is carried out subconsciously. However, for those with Apraxia, as their brains have a problem with motor planning, planning movements and carrying out tasks can be a struggle. They can do simple and natural movements better than more complex ones, as these require less brain planning than when someone commands them to do a specific movement or mimic a task. 

Symptoms 

As mentioned in the overview, Apraxia is a neurological disorder affecting motor cognition, planning and the performance of tasks.¹ 

The symptoms of Apraxia vary based on the area of the brain that has been damaged, affecting different movements and muscle groups. Similarly, symptoms can vary based on the type of Apraxia. 

Therefore, depending on the damaged area and type of Apraxia, symptoms may include:

• Speech Problems
• Difficulty with certain facial movements 
• Struggles with precise movements of limbs
• Problems mimicking movements 
• Difficulty carrying out complex tasks, involving multiple steps⁶

Types of Apraxia

There are several types of Apraxia, classified according to the movement or task performed, the affected body area, or the sensory or motor area in question. The three main types include:

• Ideomotor Apraxia: This is the most common type of Apraxia. It is characterised by difficulty or inability to carry out learned movements when commanded to perform them. It results from cerebral damage in various areas but is most commonly associated with damage to the left parietal area of the brain.^2,7 This subtype of Apraxia is commonly observed in stroke patients or those with neurodegenerative disorders²
• Ideational Apraxia: This form of Apraxia involves the loss of ability to conceptualise, plan and execute movements. Sequences of movements (those involving multiple steps) also become degraded. In ideational Apraxia interactions with everyday objects are also affected, as often people can identify these but do not know how to use them. Similar to ideomotor Apraxia, this type of Apraxia commonly develops in stroke patients and those with advanced Alzheimer's disease⁷
• Limb-kinetic Apraxia: This is another major subtype of Apraxia, despite it presenting a relatively low profile. It involves the loss of ability to make precise and coordinated finger and hand movements, causing these to be clumsy or inaccurate²

Causes of Apraxia 

Apraxia is a neurological condition that results from malfunctioning in specific brain regions, most notably the parietal lobe. It can also occur when the nerve pathways that connect the different lobes of the brain become damaged, including the frontal or temporal lobes. These areas of the brain are the ones in charge of storing the memory of learned complex movements, which is why as mentioned above, those with Apraxia often present problems with planning movements and carrying out daily tasks. Damage to other areas of the brain may also lead to Apraxia, however, this occurs less frequently.⁸ 

Some of the main causes of Apraxia include:

• Stroke
• Alzheimer's disease
• Brain tumours
• Traumatic brain injury
• Corticobasal syndrome
• Multiple sclerosis

Whilst diseases in certain areas of the brain can also cause Apraxia, stroke and dementia are the main causes. Additionally, it is important to note that the risk of developing Apraxia is dependent on an individual's risk of developing the disorders mentioned above.¹

Diagnosis and treatment

When it comes to diagnosing Apraxia, various procedures can be carried out. These include:

• Doctor’s evaluation: During these evaluations, doctors ask patients to carry out or mimic simple learned movements and tasks. For example, the doctor might ask the patient to brush their hair. Physical evaluations may also be performed to exclude problems such as muscle weakness⁸
• Neuropsychological testing: This procedure provides information regarding how the different areas of the brain are working. During this type of testing, patients are asked questions designed to evaluate aspects such as intelligence, language, motivation, speech etc. During this type of testing, the participation of a physical or occupational therapist is essential^8,9 
• Brain imaging: Tests such as computed tomography (CT) and magnetic resonance imaging (MRI) are used when the doctor believes there to be brain damage. These imaging techniques are used for assessing and determining the cause, location and extent of the brain damage⁹

Despite there being no specific treatment for Apraxia, once a diagnosis has been made, physical, speech, and occupational therapies are implemented. Physical and occupational therapies are mainly used to make the environment safer, by helping people to learn to compensate for their losses.⁸ Studies show that OT can be especially beneficial for children with Apraxia of speech, who may have difficulty with fine motor movements and coordination.¹⁰

Occupational therapy

Occupational therapy (OT) can be defined as the use of purposeful activity with individuals that have or are at risk of developing, a range of physical, developmental and mental health disorders, such as those with Apraxia. These activities are performed to maximise the independence of individuals when participating in everyday activities. Therefore, OT provides the opportunity for people to perform the activities they want and need to do.^11,12

Role of occupational therapy in treating Apraxia

OT helps patients with Apraxia, by playing an important role in improving the motor planning, coordination and cognitive challenges caused by it. Some ways in which OT can help include:

• Tailored activities: activities are performed where the specific motor challenges of the patient are addressed
• Equipment adaptations: equipment is adapted to make everyday tasks easier¹³
• Advice and support: Occupational therapists can provide support and advise those with apraxia, and their friends and family

Other treatments, such as speech therapy and physical therapy, are also used with Apraxia patients. To observe better outcomes, early identification and intervention are important.¹⁰ Additionally, therapies need to be tailored to the patient's environment, so they can be as relevant as possible to their daily life. 

Specific OT interventions for Apraxia

Amongst the different ways in which OT is used to help people with Apraxia, there are a few specific interventions³, including: 

• Strategy training: involves teaching patients to use compensatory strategies to complete everyday tasks¹⁴
• Direct activity of daily living (ADL) training: this type of training involves learning new ways to carry out everyday tasks
• Gesture training: this involves patients relearning gestures
• Sensory integration techniques: this consists of applying different elements, such as deep pressure and sharp touch to the patient's limbs. Patients with Apraxia are also asked to perform specific activities, to improve sensory processing and coordination¹⁴

Summary

Apraxia is a neurological disorder that affects a person’s ability to perform simple learned movements, making day-to-day tasks extremely challenging. Due to this OT is implemented,  playing a crucial role in aiding individuals to regain their independence by addressing coordination, motor planning and cognitive issues that these individuals may be facing. Through tailored activities and personalised strategies, OT interventions help patients relearn essential skills and tasks. This article aimed to highlight the transformative impact of OT, offering hope for improved quality of life through targeted therapeutic approaches.