Apraxia Made Easy – Ideational vs Ideomotor vs Dressing vs Constructional & More – Occupational Therapy

This article features the most common kinds of apraxia associated with occupational therapy, prognosis, and treatment.

About Apraxia

  • Apraxia is a neurological disorder that is characterized by the loss of the ability to carry out skilled movements.
  • There is usually no loss of motivation or physical ability to perform these movements.
  • Dyspraxia is a mild form of apraxia. (the a- prefix means without, so apraxia is more severe than dyspraxia)
  • Apraxia results from a dysfunction in the cerebral hemispheres of the brain in the parietal lobe.
  • Apraxias can occur alone or in a combination together.[1]NIH. (2019). Apraxia Information Page. Retrieved from https://www.ninds.nih.gov/Disorders/All-Disorders/Apraxia-Information-Page

Common Types of Apraxia

  • Anatomy descriptions of apraxia: buccofacial apraxia, orofacial apraxia, limb-kinetic apraxia, oculomotor, etc.
  • Ideomotor apraxia
  • Ideational apraxia
  • Conceptual apraxia
  • Constructional apraxia
  • Verbal apraxia, Aphasia

Other Types

  • Aphasia is a language disorder associated type of apraxia that results in the loss of ability to understand or express speech, caused by brain damage.
  • “Both aphasia and apraxia are speech disorders, and both can result from brain injury most often to areas in the left side of the brain. However apraxia is different from aphasia in that it is not an impairment of linguistic capabilities but rather of the more motor aspects of speech production. People with aphasia who also have apraxia may be further limited in their ability to compensate for the speech impairment by using informative gestures.”[2]National Aphasia Association. (n.d.). Apraxia. Retrieved from https://www.aphasia.org/aphasia-resources/apraxia/

Ideational Apraxia

Memory Trick: idea (idea is in the word)

  • Characterized by the loss of ability to conceptualize and plan a motor sequence action [sequencing].
  • “The inability to order the set of elementary movements that makes a complex action into their correct sequence.”
  • Difficulty with sequencing multi-step tasks.
  • Example: omitting, adding, or transposing steps in the sequence of movements used in pantomiming eating soup with a spoon.

Conceptual Apraxia

Memory Trick: conceptualizing

Sometimes used synonymously with ideational apraxia. Conceptual apraxia is more specifically:

  • The perception of an object’s intended purpose is lost.[3] Buxbaum LJ, Schwartz MF, Montgomery MW (1998). “Ideational apraxia and naturalistic action”. Cognitive Neuropsychology. 15 (6–8): 617–43. doi:10.1080/026432998381032. PMID 22448839.
  • Using a tool incorrectly or not for its intended purpose.
  • “What is this and what is it used for?”
  • Examples: writing with scissors, or brushing teeth using a spoon.[4]Peigneux, P. (2010). Current Models and Assessment of Limb Apraxia. Encyclopedia of Behavioral Neuroscience.

Ideomotor Apraxia

Memory Trick: the motor in ideomotor dyspraxia; idea is in the word, but is spelled with an ‘o’, so pay more attention to the motor. Ideational apraxia (see above) is where you pay more attention to the ‘idea’ as it is spelled correctly with an ‘a’.

  • Can conceptualize the action cognitively.
  • Deficit of the execution of action upon request (verbal command) or imitation.
  • Often can execute spontaneous actions such as gestures and one-step tasks, e.g., automatic actions.
  • Examples: pretending to use a hammer, brushing one’s hair, waving goodbye.[5]Wheaton LA, Hallett M. Ideomotor apraxia: a review. J Neurol Sci. 2007 Sep 15;260(1-2):1-10. doi: 10.1016/j.jns.2007.04.014. Epub 2007 May 16. PMID: 17507030.
  • OT can be effective to help regain functional control.
  • One approach involves breaking down the task into separate components and teaching them individually until mastered.
  • Requires repetition.[6]Sunderland, A.; Shinner, C. (Apr 2007). “Ideomotor apraxia and functional ability”. Cortex. 43 (3): 359–67. doi:10.1016/S0010-9452(08)70461-1. PMID 17533759. S2CID 4484338.

Constructional Apraxia

Memory Trick: construction paper

  • Impairment of 2-dimensional and 3-dimensional tasks.
  • Difficulty arranging, building, and drawing in 2D or 3D space.
  • “Inability to reproduce or accurately construct a representation of a named or viewed visual stimulus despite adequate limb strength and physical and visual capacity.”[7]Pelak, V. (2020). Visual Cortical Disorders. Reference Module in Neuroscience and Biobehavioral Psychology
  • Common after a right parietal stroke.[8]Russell C, Deidda C, Malhotra P, Crinion JT, Merola S, Husain M. A deficit of spatial remapping in constructional apraxia after right-hemisphere stroke. Brain. 2010 Apr;133(Pt 4):1239-51. doi: … Reference List
  • Common in Alzheimer’s disease, Lewy Body Dementia, and other neurodegenerative dementing disorders.[9]Trojano, L., & Gainotti, G. (2016). Drawing disorders in Alzheimer’s disease and other forms of dementia. Journal of Alzheimer’s Disease, 53(1), 31-52.
  • Often associated with general mental impairment.
  • Performance varies even with the same individual as tasks that involve assembly and building are different than drawing tasks.[10]Hamsher, K. (1998). Intelligence and Aphasia. Acquired Aphasia: 3rd Edition
  • Example: inability to accurately copy drawings, e.g., 3D cube in MoCA test.
  • Difficulty with clock drawing, poor performance in MMSE

Dressing Apraxia

  • Characterized by the difficulty with the automatic and spontaneous capacity for dressing (donning and doffing clothes).[11]Haughey, F., Morgan, J. M., & Stapleton, T. (2012). A case of dressing apraxia? A case study. International Journal of Therapy and Rehabilitation, 19(12), 704-710.
  • Often associated with right parietal lobe lesions, e.g., CVA.[12]Ceccaldi M, Poncet M, Gambarelli D, Guinot H, Bille J. Progressive severity of left unilateral apraxia in 2 cases of Alzheimer’s disease. Rev Neurol. 1995;151: 240-246.[13]Rapcsak S Z, Ochipa C, Anderson K C, Poizner H. Progressive ideomotor apraxia: evidence for a selective impairment of the action production system. Brain Cogn. 1995;27:213-236.[14]Hier DB, Mondlock J, Caplan LR. Behavioral abnormalities after right hemi- sphere stroke. Neurology. 1983;33:337-344.
  • Associated with difficulty in visual matching (perceptual), spatial abilities, and cancellation tasks for visual inattention.[15]Walker, M. F., & Lincoln, N. B. (1991). Factors influencing dressing performance after stroke. Journal of Neurology, Neurosurgery & Psychiatry, 54(8), 699-701.
  • Examples: putting on a t-shirt backward – “Is this the front or the back?”

Prognosis

The prognosis varies depending on the underlying cause, severity, and other factors. Improvement arises from significant to mild if any.

Treatment

  • Treating the underlying condition.
  • Occupational therapy
  • Speech therapy
  • Physical therapy

Interventions

Source[16]West, C., Bowen, A., Hesketh, A., & Vail, A. (2008). Interventions for motor apraxia following stroke. The Cochrane database of systematic reviews, 2008(1), CD004132. … Reference List

  • Strategy training in daily living activities: this technique teaches internal (for example, the patient is taught to verbalise and implement the task steps at the same time) or external (for example, when aids are used to overcome a functional barrier) compensatory strategies that enable a functional task to be completed. These strategies will not have been used prior to the stroke ();

  • Sensory stimulation: stimulations including deep pressure, sharp and soft touch are applied to the patients’ limbs ();

  • Proprioceptive stimulation: the patient leans on and puts weight through their upper and lower limbs;

  • Cueing, verbal or physical prompts: given to enable each stage of the task to be completed;

  • Chaining (forward or backward): the task is broken down into its component parts. Using backward chaining the task is completed with facilitation from the therapist apart from the final component, which the patient carries out unaided. If successful next time further steps are introduced. Forward chaining is the reverse of backward chaining;

  • Normal movement approaches: the therapist facilitates the body through normal movement patterns.

References

References
1 NIH. (2019). Apraxia Information Page. Retrieved from https://www.ninds.nih.gov/Disorders/All-Disorders/Apraxia-Information-Page
2 National Aphasia Association. (n.d.). Apraxia. Retrieved from https://www.aphasia.org/aphasia-resources/apraxia/
3 Buxbaum LJ, Schwartz MF, Montgomery MW (1998). “Ideational apraxia and naturalistic action”. Cognitive Neuropsychology. 15 (6–8): 617–43. doi:10.1080/026432998381032. PMID 22448839.
4 Peigneux, P. (2010). Current Models and Assessment of Limb Apraxia. Encyclopedia of Behavioral Neuroscience.
5 Wheaton LA, Hallett M. Ideomotor apraxia: a review. J Neurol Sci. 2007 Sep 15;260(1-2):1-10. doi: 10.1016/j.jns.2007.04.014. Epub 2007 May 16. PMID: 17507030.
6 Sunderland, A.; Shinner, C. (Apr 2007). “Ideomotor apraxia and functional ability”. Cortex. 43 (3): 359–67. doi:10.1016/S0010-9452(08)70461-1. PMID 17533759. S2CID 4484338.
7 Pelak, V. (2020). Visual Cortical Disorders. Reference Module in Neuroscience and Biobehavioral Psychology
8 Russell C, Deidda C, Malhotra P, Crinion JT, Merola S, Husain M. A deficit of spatial remapping in constructional apraxia after right-hemisphere stroke. Brain. 2010 Apr;133(Pt 4):1239-51. doi: 10.1093/brain/awq052. PMID: 20375139.
9 Trojano, L., & Gainotti, G. (2016). Drawing disorders in Alzheimer’s disease and other forms of dementia. Journal of Alzheimer’s Disease, 53(1), 31-52.
10 Hamsher, K. (1998). Intelligence and Aphasia. Acquired Aphasia: 3rd Edition
11 Haughey, F., Morgan, J. M., & Stapleton, T. (2012). A case of dressing apraxia? A case study. International Journal of Therapy and Rehabilitation, 19(12), 704-710.
12 Ceccaldi M, Poncet M, Gambarelli D, Guinot H, Bille J. Progressive severity of left unilateral apraxia in 2 cases of Alzheimer’s disease. Rev Neurol. 1995;151: 240-246.
13 Rapcsak S Z, Ochipa C, Anderson K C, Poizner H. Progressive ideomotor apraxia: evidence for a selective impairment of the action production system. Brain Cogn. 1995;27:213-236.
14 Hier DB, Mondlock J, Caplan LR. Behavioral abnormalities after right hemi- sphere stroke. Neurology. 1983;33:337-344.
15 Walker, M. F., & Lincoln, N. B. (1991). Factors influencing dressing performance after stroke. Journal of Neurology, Neurosurgery & Psychiatry, 54(8), 699-701.
16 West, C., Bowen, A., Hesketh, A., & Vail, A. (2008). Interventions for motor apraxia following stroke. The Cochrane database of systematic reviews, 2008(1), CD004132. https://doi.org/10.1002/14651858.CD004132.pub2
Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, culture, sociology, philosophy, and more.