Types of Apraxia and How They Are Treated

Apraxia is a neurological disorder caused by damage to parts of the brain that regulate motor planning. Motor planning is an essential function in which the brain processes information to prepare for movements like taking a step to walk or forming words with your mouth to speak.

When communication between the brain and body is disrupted, it can interfere with your ability to coordinate movements, perform sequential tasks, talk, or even make facial expressions.

Apraxia is most often due to brain damage caused by stroke, a traumatic brain injury, or a neurodegenerative disorder like Alzheimer's disease. The treatment involves physical, occupational, and/or speech therapy.

This article describes different types of apraxia, including their symptoms and causes. It also explains how this often debilitating disorder is diagnosed and treated.

What Are the Different Types of Apraxia?

There are different types of apraxia that interfere with your ability to perform everyday tasks and movements. With certain brain injuries, it is possible to have more than one type at the same time.

The seven main types of apraxia include:

• Ideomotor apraxia: The inability to act out a movement, such as turning a doorknob, even though you can describe how it is done
• Ideational apraxia: The inability to conceptualize and perform tasks that involve multiple sequential movements (such as putting on your socks before your shoes)
• Limb-kinetic apraxia: The inability to make precise, coordinated finger and hand movements (such as buttoning a shirt)
• Buccofacial/orofacial apraxia: The inability to perform facial movements on demand (such as licking lips, whistling, or winking)
• Verbal apraxia (apraxia of speech): Difficulty coordinating mouth movements to produce speech
• Constructional apraxia: The inability to copy or draw objects or symbols
• Oculomotor apraxia: The inability to move your eyes on demand

What Are Examples of Apraxia?

Apraxia causes difficulty performing everyday tasks and activities of daily living despite no damage to muscle tone or strength.

People with apraxia will often struggle with:

• Dressing
• Brushing teeth
• Brushing hair
• Bathing
• Toileting
• Cooking
• Cleaning
• Housework
• Writing
• Grasping tools 

Verbal apraxia (also called apraxia of speech) uniquely affects the planning and sequencing of motor movements used to produce speech, which can cause difficulty pronouncing words, distorted speech, and speech errors.

What Causes of Apraxia?

Apraxia is caused by damage to parts of the left side of the brain (the hemisphere responsible for speech and abstract thinking). Those specifically involved with motor planning include the following areas:

• Left temporal lobe which accesses memories and learned behaviors involved with movement
• Left parietal cortex which processes spatial information to coordinate body movements
• Left premotor cortex which processes information used for motor planning

Apraxia may also be caused by damage to the corpus callosum, the bundle of fibers that connect the left side of the brain to the right side of the brain.

Conditions that can cause damage to these parts of the brain include:

• Stroke: Caused by the loss of blood flow to the brain
• Dementia: A group of conditions that cause loss of memory, cognition, and executive function
• Alzheimer's disease: The most common form of dementia
• Parkinson’s disease: A progressive neurodegenerative disorder affecting movement
• Huntington's disease: A progressive neurodegenerative disorder that can lead to dementia
• Brain tumor: A growth of abnormal cells in the brain, both cancerous and non-cancerous
• Traumatic brain injury: An injury affecting how the brain works
• Hydrocephalus: The buildup of fluid in the brain
• Corticobasal syndrome: A rare neurological disorder causing the brain to shrink
• Progressive supranuclear palsy: A rare brain disorder that impacts balance and movement

How Apraxia Is Diagnosed

Apraxia often requires the input of a specialist in nervous system disorders called a neurologist. During the investigation, the specialist will test your muscle strength, range of motion, coordination, and cognition.  A 20-minute, in-office test called the Test of Upper Limb Apraxia (TULIA) can also be used.

During the TULIA, the provider will demonstrate movements and then ask you to reproduce the movements as precisely as possible, such as:

• Putting your index finger on top of your nose
• Placing your hand flat on top of your head
• Wiping dust from your shoulder
• Saluting like a soldier
• Making the hitchhiking gesture
• Combing your hair
• Brushing your teeth
• Using scissors
• Scratching your head
• Blowing a kiss
• Waving goodbye

Each movement is scored between 0 (meaning no movement) and 5 (meaning normal movement). Lower TULIA scores indicate greater severity of apraxia.

To help characterize the underlying cause of apraxia, additional tests may be ordered, including:

• Brain imaging scans: Such as magnetic resonance imaging (MRI) and computed tomography (CT)
• Electroencephalogram (EEG): Used to measure electrical brain activity
• Lumbar puncture: Also called a spinal tap, used to check for infection or intracranial pressure

How Is Apraxia Treated?

There are no medications able to treat or improve apraxia. Rehabilitation is the main form of treatment for apraxia, which can consist of:

• Physical therapy: To increase strength, coordination, and motor control
• Occupational therapy: To develop strategies to overcome motor limitations
• Speech therapy: To improve the pronunciation of speech sounds

Transcranial direct current stimulation (TDCS) is an experimental therapy involving a low electrical current to the brain that some studies suggest may help people with limb-kinetic apraxia. While considered safe, TDCS is not approved by the FDA for any condition.

Prognosis

Apraxia is a difficult condition to treat as it often results from permanent brain damage or neurodegenerative conditions that worsen over time.

With that said, recovery can and does occur, but the odds vary from one case to the next. Some people improve significantly, while others experience no improvement despite optimal treatment.

The chances of recovery are largely influenced by the underlying cause, the severity and extent of brain tissue damage, and possibly your age and general health. When working with a neurologist, it is important to approach treatment with optimism and commitment but also with realistic expectations.

Summary 

Apraxia is a neurological disorder characterized by an inability to perform everyday movements, despite having normal muscle tone and strength. This is due to problems with cognition and motor planning, which can interfere with daily living. Different forms of ataxia include ideomotor, ideational, limb-kinetic, buccofacial/orofacial, verbal, constructional, and oculomotor.

Apraxia results from damage to regions within the left side of the brain, especially from stroke, traumatic brain injury, Parkinson's disease, or dementia. Rehabilitation including physical, occupational, and speech therapy can be used to help regain function.