What Is Apraxia?

Overview

Apraxia is a neurological disorder that affects someone’s ability to perform voluntary movements even though they have the physical capability to do so. It arises from damage to areas of the brain responsible for controlling voluntary movements. 

Different types of apraxia are associated with the loss of ability to carry out different types of voluntary movement and difficulties with speech.¹ Occupational therapy, speech therapy and physical therapy are used in combination to treat apraxia. They aim to improve a person's functional capabilities and therefore, their quality of life.

Causes of apraxia

According to the National Institute of Neurological Disorders and Stroke, apraxia is caused by damage to specific areas of the brain that are responsible for movement coordination and senses, such as taste, hearing and touch. 

The damage to the brain that results in apraxia can be caused by head injury or diseases that affect the brain. These include:

• Stroke (disrupts the flow of blood to the brain)
• Traumatic brain injury (apraxia may be caused depending on the location of the brain injury)
• Brain tumours (may be within or pressing on areas related to motor control)
• Degenerative neurological disorders (e.g. Alzheimer's disease or Parkinson's disease)¹
• Brain infections (e.g. encephalitis or meningitis)

As older adults have a higher incidence rate of degenerative neurological disease, they also have a higher likelihood of apraxia.

If apraxia is caused by a stroke, the symptoms of apraxia may improve as the brain swelling goes down.

In rare cases, apraxia may also be caused by genetics. It can occur as part of other disorders, for example, autism and epilepsy amongst others. In addition, a mutation in a gene called FOXP2 may also cause a type of apraxia called childhood apraxia of speech (CAS). 

Signs and symptoms of apraxia

The signs and symptoms of apraxia can vary depending on the specific region of the brain affected and the severity of the damage. Despite this, there are some common signs and symptoms associated with the condition. These include:²

• Having trouble with voluntary movements despite a physical capability to perform them. This symptom may be worse when asked to perform an action on command
• Inaccurate/inconsistent movement which may seem mis-timed or mis-ordered
• Difficulty with complex tasks. Tasks that have multiple steps can be a struggle. Examples of these include brushing teeth and getting dressed
• Impaired speech and language affects those with apraxia of speech. People with apraxia of speech may find it hard to articulate words, create the correct sounds and time what they are saying
• Issues with non-verbal communication which can include gestures such as waving
• Frustration when unable to complete actions

Management and treatment for apraxia

Apraxia is usually managed using a multidisciplinary approach. A team is employed to treat the individual’s specific needs based on the effects and severity of the apraxia. The common components for the management and treatment of apraxia include:^3,4

• Speech therapy is particularly useful for managing apraxia of speech⁴
• Occupational therapy is used to improve the ability to perform daily tasks 
• Physical therapy helps individuals improve coordination, strength, balance and mobility using targeted exercises³
• Augmentative and alternative communication devices can be used when speech is severely affected by apraxia. Examples include communication boards and electronic devices
• Environmental modifications and adaptive devices may help people with apraxia go about day-to-day activities more easily
• Home practice and support is crucial for people with apraxia. This can be from family members, friends or caregivers
• Supportive counselling may help you to deal with the emotional and psychological toll living with apraxia can have. Counselling helps with support, education and coping strategies to manage the emotional impact of the condition

Diagnosis of apraxia

Apraxia is diagnosed by healthcare professionals. Different types of healthcare professionals are involved in an apraxia diagnosis to give a comprehensive evaluation. 

Initially, your doctor will ask about your symptoms, their onset and progression, and your medical history. They may then perform a physical examination to assess your neurological functioning. This neurological evaluation will assess your motor skills and coordination.⁵ 

If your speech is affected, a speech-language assessment will usually be performed by a speech-language pathologist.⁶ Additional standardised tests may be conducted to determine whether or not you have apraxia.

In some cases, imaging tests may be used to identify possible underlying causes of apraxia. These imaging tests could be an MRI scan or a CT scan.

Healthcare professionals will also want to rule out any other possible causes of your symptoms. Therefore, they may test for other conditions that could lead to motor difficulty. 

FAQs

Can apraxia be prevented?

As apraxia is caused by damage to the brain, and many of the causes of this damage are not preventable, apraxia cannot be prevented entirely. However, steps you can take include practising safety measures (to reduce risk of injury and accidents), maintain a healthy lifestyle, and managing underlying health conditions that could potentially lead to apraxia. 

How common is apraxia?

Apraxia is generally considered to be a rare health condition, but its prevalence in the general population is unclear. However, studies have found apraxia to affect 90% of dementia patients, 30%-80% of stroke patients, 19-45% of those with traumatic brain injuries, and 25% of multiple sclerosis patients.⁷ 

Who is at risk of apraxia?

Apraxia may develop in individuals of all ages. However, the risk of apraxia can increase with age due to an increased risk of neurodegenerative disease and strokes.

Additionally, those who have had strokes or traumatic brain injuries are at an increased risk of apraxia, as well as those with neurodegenerative disease, a genetic predisposition or brain tumours/lesions. 

When should I see a doctor?

If you or your child is experiencing symptoms indicative of apraxia, you should contact your doctor. 

Summary

To summarise, apraxia is a neurological condition that can affect a person’s voluntary movements and speech. It is caused by damage to the brain, and therefore it is difficult to prevent. The symptoms vary by case, however, issues with movement and/or speech are the most common. If you suspect you or your child may have apraxia, you should contact a healthcare professional.