From the Guidelines
Apraxia should be managed with individually tailored interventions, including behavioral techniques and strategies that target physiological support for speech, and global aspects of speech production, as well as environmental modifications and activities to facilitate social participation and promote psychosocial well-being. Apraxia is a neurological disorder characterized by the inability to perform purposeful movements despite having the physical ability and desire to do so. It occurs due to damage in specific areas of the brain that control learned movements. There are several types of apraxia, including limb apraxia (difficulty with purposeful limb movements), ideational apraxia (trouble with sequential tasks), and apraxia of speech (difficulty planning and coordinating speech movements). Treatment typically involves speech therapy for speech apraxia or occupational therapy for limb apraxia, focusing on repetitive practice of movements and alternative communication strategies, as recommended by the American Heart Association/American Stroke Association guidelines 1.
Some key strategies for managing apraxia include:
- Physiological support for speech, including respiration, phonation, articulation, and resonance
- Global aspects of speech production such as loudness, rate, and prosody
- Augmentative and alternative communication devices and modalities to supplement speech
- Environmental modifications, including listener education, to improve communication effectiveness
- Activities to facilitate social participation and promote psychosocial well-being, as suggested by the guidelines 1.
It is also important to note that task practice for apraxia with and without mental rehearsal may be considered, as well as strategy training or gesture training for apraxia, as recommended by the American Heart Association/American Stroke Association guidelines 1. No specific medications directly treat apraxia, but underlying conditions like stroke or neurodegenerative diseases may require medical management. Recovery depends on the cause, extent of brain damage, and early intervention. Apraxia differs from paralysis as the muscles themselves function normally; the problem lies in the brain's ability to plan and coordinate learned movements.
From the Research
Definition and Classification of Apraxia
- Apraxia is a higher-order motor disorder that impairs the ability to correctly perform skilled, purposive movements as a result of neurological disorders, such as stroke, dementia, and movement disorders 2.
- It can be classified into subtypes, including ideomotor, ideational, and limb-kinetic apraxia 3, 4.
- Ideomotor apraxia is characterized by difficulty in using tools, such as scissors, while ideational apraxia is characterized by difficulty in performing complex actions, such as making a cup of coffee 3.
Impact of Apraxia on Daily Life
- Apraxia can negatively impact activities of daily living (ADL) and quality of life 2, 4.
- Patients with apraxia may have difficulty managing daily tasks, such as cooking, dressing, and grooming, which can lead to increased caregiver burden and healthcare costs 3.
- Apraxia is a common disorder, affecting up to 50% of left brain-damaged patients and 20% of right brain-damaged patients 5.
Assessment and Treatment of Apraxia
- Early diagnosis and treatment of apraxia are essential for improving outcomes and reducing the impact on daily life 2.
- Assessment of apraxia involves evaluating the patient's ability to perform skilled movements and identifying the underlying cognitive-motor deficits 3.
- Treatment of apraxia may involve physiotherapy, speech therapy, and other interventions, such as motor training and noninvasive brain stimulation 5, 4.
- While some studies have shown promising results for these interventions, more research is needed to determine the most effective approaches and to develop evidence-based guidelines for treatment 5.