Merck Manual

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Apraxia

By

Juebin Huang

, MD, PhD, Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center

Last full review/revision Sep 2020| Content last modified Sep 2020
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Apraxia is loss of the ability to do tasks that require remembering patterns or sequences of movements.

  • People with apraxia cannot remember or do the sequence of movements needed to complete simple skilled or complex tasks, even though they are physically able to do the tasks.

  • Doctors ask the person to do or imitate common learned tasks, and tests of brain function and imaging tests may be done.

  • Physical and occupational therapists can help by making the environment safer and by providing devices to enable people with apraxia function better.

Apraxia is relatively uncommon.

Causes

Apraxia is usually caused by damage to the parietal lobes or to nerve pathways that connect these lobes to other parts of the brain, such as frontal and/or temporal lobes. These areas store memories of learned sequences of movements. Less often, apraxia results from damage to other areas of the brain.

Damage may result from a stroke, a brain tumor, a head injury, or dementia.

Symptoms

People with apraxia cannot remember or do the sequence of movements needed to complete simple skilled or complex tasks, even though they have the physical ability to do the task and they can do the individual movements of the task. For example, buttoning a button, which consists of a series of steps, may be impossible, even though the hands are physically capable of doing the task. Typically, people do not realize that they have a problem.

Some forms of apraxia affect only particular tasks. For example, people may lose the ability to do any one of the following: draw a picture, write a note, button a jacket, tie a shoelace, pick up a telephone receiver, or play a musical instrument. They may not be able to make or imitate hand gestures (such as waving goodbye) or show how a tool (such as a toothbrush) is used. They may be unable to copy a simple geometric shape despite being able to see and recognize it, hold and use a pen, and understand the task.

People with verbal (speech) apraxia cannot produce the basic sound units of speech because they cannot initiate, coordinate, or sequence the muscle movements needed to talk.

Diagnosis

  • A doctor's evaluation

  • Standardized tests of brain function

  • Imaging tests, such as computed tomography or magnetic resonance imaging

To diagnose apraxia, doctors ask the person to do or imitate common learned tasks, such as using a toothbrush, scissors, or a screwdriver. Doctors also do a physical examination to determine whether symptoms are caused by muscle weakness or a muscle or joint problem.

Family members or caregivers are asked how well the person does daily activities, such as eating with utensils, preparing meals, and writing.

Certain standardized tests of brain function (neuropsychologic testing) may be done. Neuropsychologic testing provides information about how different areas of the brain are functioning. Doctors ask people questions designed to evaluate intelligence, the ability to solve problems and to plan and initiate actions (called executive function), attention, memory, language, motivation, mood and emotion, quality of life, and personality. Doctors also do simple tests and ask people to do specific movements to evaluate how well their brain processes the request (such as asking them to wave goodbye or show how a hammer is used).

Imaging tests, such as computed tomography (CT) or magnetic resonance imaging (MRI), and other tests are done to determine the cause of the brain damage.

Prognosis

Depending on the cause, some people with apraxia continue to lose function and become dependent, requiring help with daily activities and some supervision. However, if apraxia results from a stroke, people may not continue to lose function and may even improve somewhat, especially if they have intensive rehabilitation that includes occupational therapy.

Treatment

  • Treatment of the cause

  • Physical and occupational therapy

The disorder causing apraxia is treated if possible. There is no specific treatment for apraxia.

Physical and occupational therapy may help some people with apraxia learn to compensate for their losses. But the main use of these therapies is to make the environment safer and to provide devices that help people function better.

Speech therapists can help people who have verbal apraxia by asking them practice making sound patterns over and over. If verbal apraxia is severe, people may be taught to use a letter or picture board or a electronic communication device with a keyboard and message display.

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
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