Throughout the course of a day, the human body is constantly coordinating movement. Routine actions that might seem effortless, like waving hello, catching a ball, or using a toothbrush, are actually the result of the brain sending a precise series of messages to the limbs to move the muscles. Therapists often use the term “motor planning” to refer to the ability to perform movements in the right order to form actions.(1) However, when brain areas controlling movement are damaged, a breakdown in motor planning can occur. This breakdown can also be referred to as apraxia.
Apraxia is a disorder that can result from a stroke, brain injury, brain tumor, or neurodegenerative disease. This condition usually results from damage to the left hemisphere of the brain and can affect one or more areas of the body, including the arms, legs, or even the face.(2) The scientific community has not yet reached an agreement on the many proposed forms of apraxia or how to classify them.(3) For purposes of this article, we will explore how apraxia can affect actions related to arm movements and how this condition can be treated by therapists and caregivers alike.
Apraxic movement errors are not caused by one-sided arm weakness related to a neurological event (see hemiplegia). In fact, a person who has apraxia might not have noticeable arm weakness at all. Instead, they might look like their arm movements are slowed down or clumsy. This is because their brain has lost the ability to smoothly motor plan actions from start to finish. They may now need to spend more time thinking through the individual steps of a task.
Apraxia can affect a person’s ability to perform or copy a gesture, even after being asked and given a visual demonstration. Someone with apraxia may not be able to mimic the thumbs up or down sign or wave upon command. Apraxia can also cause reduced understanding of the purpose of objects, resulting in incorrect tool use.(4) For example, a person with apraxia might demonstrate using a hammer by holding it upside down or raking it across a table. They might bring a hairbrush to their mouth or brush their hair in upward strokes instead of downward.
Copying a simple gesture might be difficult for someone with apraxia, as they may no longer understand its meaning.
The automatic ability to perform a familiar movement or use a common object may be preserved despite apraxia. An affected individual might be able to pick up a telephone as it rings or spontaneously wave goodbye to a family member even when they cannot demonstrate either action upon command. Automatic performance of arm movements may not always be present or retained consistently.(5) Regardless, it is important to note that, when working with individuals with apraxia, it is best to practice re-learning simple tasks in their natural context for maximum skill carryover.
A good approach to helping someone with apraxia is establishing a consistent routine of daily tasks.(6) A well-rounded routine can include eating meals, getting dressed, performing hygiene, and completing familiar chores or leisure activities. It is advised to structure basic tasks in the same order every day as able, and to minimize distractions in the environment (limit unnecessary items and noise) so the affected individual can stay focused. Provide hand-over-hand guidance in addition to verbal instructions if the individual seems stuck on a movement or begins to perform it incorrectly. Once you have begun guiding the correct movement pattern, attempt to fade guidance to see if the individual can continue the step of the task or perform the remainder of the action by themselves.
Remove clutter and unnecessary items in common workspaces to maximize success.
Through repetition of familiar actions and task grading (adjusting a daily routine to include easier or more complicated tasks based on performance) it is thought that movement patterns can be restored so that actions are performed more automatically. However, for some individuals, apraxia will be a long-lasting condition.(7) It is important to be patient and understanding when interacting with someone with apraxia, as they might need more time or some extra physical help to get started doing the things they want to do.
As apraxia often occurs alongside aphasia, a communication disorder, it is important to provide multiple ways to understand the task at hand whether it is verbal, written, or visual instruction via demonstration or pictures.(8) It is also advised to consider related coordination disorders when diagnosing apraxia, including ataxia (to be discussed in an upcoming blog post). If you are unsure whether the symptoms you or a loved one is exhibiting are related to apraxia, discuss your concerns with a medical or therapy team.
The NEOFECT line of Smart Rehabilitation Solutions can assist with coordination difficulties stemming from stroke or other neurological diagnoses. Our neurorehabilitation products include support from occupational therapists to maximize your functional gains. Please call (866) 534-4989 or email firstname.lastname@example.org for further inquiry.
- Wong AL, Haith AM, Krakauer JW. Motor Planning. The Neuroscientist. 2014;21(4):385-398. doi:10.1177/1073858414541484.
- Gross R. G., Grossman M. (2008). Update on apraxia. Curr. Neurol. Neurosci. Rep. 8 490–496. 10.1007/s11910-008-0078-y
- Petreska B, Adriani M, Blanke O, Billard AG. Apraxia: a review. Prog Brain Res. 2007;164:61–83.
- Fernandez YM, Frucht SJ. Primary progressive apraxia: an unusual ideomotor syndrome. Journal of Clinical Movement Disorders. 2017;4(1). doi:10.1186/s40734-017-0064-0.
- Rapcsak S, Ochipa C, Beeson P, Rubens A. Praxis and the Right Hemisphere. Brain and Cognition. 1993;23(2):181-202. doi:10.1006/brcg.1993.1054.
- Heugten CV, Geusgens C. Strategies to Compensate for Apraxia Among Stroke Clients. International Handbook of Occupational Therapy Interventions. January 2009:241-248. doi:10.1007/978-0-387-75424-6_22.
- Donkervoort M, Dekker J, Deelman B. The course of apraxia and ADL functioning in left hemisphere stroke patients treated in rehabilitation centres and nursing homes. Clinical Rehabilitation. 2006;20(12):1085-1093. doi:10.1177/0269215506071257.
- Kobayashi S, Ugawa Y (2013) Relationships between Aphasia and Apraxia. J Neurol Transl Neurosci 2(1): 1028.
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