What is Apraxia?
Apraxia is a decrease or difficulty in performing purposeful, skilled movements that cannot be attributed to hemiplegia or lack of effort. 1
Types and Characteristics
Limb apraxia is more common after left hemispheric than right hemispheric stroke and is associated with reduced independence in daily life activities 1
Ideomotor apraxia involves difficulty performing learned, skilled gestures despite understanding the task and having the physical ability to perform the movements 2, 3
Ideational apraxia refers to difficulty conceptualizing and sequencing the steps needed to complete a complex task 2, 4
Limb-kinetic apraxia involves loss of dexterity and fine motor control that cannot be explained by elemental motor disorders 4, 5
Neuroanatomical Basis
Apraxia involves dysfunction in a large-scale network including frontal, parietal, and basal ganglia regions 2, 3
Both hemispheres can be involved in apraxia, with studies showing that stroke to either hemisphere can selectively impair different stages of action production 6
Apraxia is a hallmark of corticobasal degeneration but can also be present in other neurological conditions including progressive supranuclear palsy, Parkinson's disease, Alzheimer's disease, and frontotemporal dementias 4
Clinical Impact
Apraxia negatively affects quality of life and independence in daily activities 1, 2
Despite not traditionally being believed to affect daily function, evidence now shows that apraxia is associated with reduced independence in activities of daily living 1
Apraxia can coexist with other post-stroke deficits such as aphasia, which can further complicate rehabilitation 1
Assessment and Diagnosis
Diagnosis involves differentiating apraxia from primary motor deficits (weakness, spasticity) and other neurological conditions 4
Assessment should include observation of purposeful movements, gesture production (both pantomime and imitation), and tool use 5, 6
Evaluation should distinguish between different types of apraxia to guide appropriate treatment 2, 5
Treatment Approaches
Strategy training or gesture training may be considered for apraxia (Level IIb, B evidence) 1
Task practice with and without mental rehearsal may be considered (Level IIb, C evidence) 1
Intensive practice of gestures or daily activities has shown promising results 5
New technologies like virtual reality and brain stimulation offer fresh opportunities for assessment and therapy 5
Pitfalls and Caveats
The term "apraxia" has sometimes been misapplied to other motor disturbances such as "gait apraxia" and "apraxia of eyelid opening," demonstrating inconsistent nomenclature in this field 4
Distinguishing limb-kinetic apraxia from bradykinesia and dystonia in patients with movement disorders can be challenging 4
Despite new technologies, progress in apraxia therapy research has been marginal, highlighting the need for more focused research in this area 5
The presence of aphasia can complicate the assessment and treatment of apraxia, as communication difficulties may interfere with understanding instructions 1