What causes apraxia and dyspraxia

Von, medical editor and biologist
and, medical journalist
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Apraxia patients cannot consciously move in a purposeful manner. It is therefore impossible for you to use everyday objects such as cutlery, glasses or bottles properly. The interplay of perception and voluntary movements (sensorimotor functions) is not disturbed, however. There are also no problems with attention or understanding. The apraxia usually manifests itself after left-sided brain damage, such as a stroke. Learn more about apraxia here.

Brief overview

  • What is apraxia? Motor problems, consciously performing targeted movement sequences - despite intact motor functions. Usually affects both sides of the body and is often associated with a speech disorder (aphasia).
  • causes: Damage to the left side of the brain, mostly from a stroke. Other causes: Alzheimer's disease, other forms of dementia, e.g. B. Lewy body dementia, frontotemporal dementia (Pick's disease).
  • to shape: Ideatory apraxia (those affected can no longer imagine and logically plan certain movement sequences), ideomotor apraxia (sequences of movements are conceivable but not feasible, but sometimes the person affected can imitate them), buccofacial apraxia (sub-form of ideatory apraxia that affects the facial muscles ).
  • diagnosis: Initial discussion (anamnesis) with patients or relatives and nursing staff (external anamnesis), various examinations and tests (e.g. request to make certain hand or finger movements or to use a tool). In buccofacial apraxia: check of facial movements (e.g. tongue clicking)
  • treatment: only necessary if the apraxia severely affects the person concerned in everyday life. Then occupational therapy can help.

Apraxia: description

An apraxia manifests itself through motor failures. However, these are not based on a physical disability - the patients are neither paralyzed nor impaired in their ability to coordinate. Nevertheless, they do not succeed in consciously performing targeted movements or in using everyday objects such as cutlery or tools without errors.

Apraxia usually occurs after damage to the left side of the brain, especially after a stroke. It usually affects both halves of the body and is often associated with a speech disorder (aphasia). Often the right side of the body is paralyzed at the same time during apraxia. Then the symptoms of the disease can only be seen on the left, still mobile side of the body.

Frequency of apraxia

Apraxia often occurs after damage to the left side of the brain, such as after a stroke. About a third to a half of the patients can no longer imitate certain movements after such damage. If one only considers patients who have aphasia as a result of the damage, it is even two thirds.

Apraxia: causes

Apraxia occurs when the language-dominant hemisphere of the brain has been damaged. Mostly a left-sided, sometimes a bilateral stroke is behind it. In addition, degenerative diseases, especially Alzheimer's disease, can trigger apraxia. Other forms of dementia, such as Lewy body dementia or frontotemporal dementia (Pick's disease) are also possible causes.

Apraxia: forms

A distinction is made between different forms of apraxia. The most common are ideatory and ideomotor apraxia.

Ideatory apraxia

In ideatory apraxia, those affected can no longer imagine certain movement sequences (i.e. imagine). That is why they cannot logically plan these processes. For example, they first coat a bread roll with jam before cutting it open instead of the other way around. Or you can open a bottle and close it again immediately without transferring the liquid contained in the bottle into a glass.

Ideomotor apraxia

Ideomotor apraxia is much more common. Here, those affected can correctly imagine a sequence of movements, but they cannot perform it. However, some can imitate the consequences of actions - such as opening a bottle or filling a glass - if they have been shown them beforehand.

It is also not possible for other affected persons to imitate targeted movements.

With a sub-form, the buccofacial apraxia, those affected are unable to move their facial muscles in a targeted manner. Patients cannot perform movements such as wrinkling their noses or clicking their tongues when prompted or by imitation. However, such movements are usually possible spontaneously (i.e. without those affected being aware of the movements).

Other forms of apraxia

There are other forms of apraxia that are not related to the apraxia described above in the narrower sense. This includes, for example, lid apraxia. Those affected by this cannot open or close their eyes at will.

Speech apraxia is also one of the special forms. It is not possible for the patient to plan and execute the movement sequences responsible for speaking. This affects the articulation, the speaking melody and the speaking rhythm as well as the speaking behavior. Speech apraxia is often associated with aphasia.

diagnosis

If apraxia is suspected, the doctor will first take the medical history (anamnesis). He often needs support: Since those affected usually also suffer from a speech disorder (aphasia), the relatives and the nursing staff are in demand here (third-party anamnesis). Important information is, for example, observations regarding patient behavior: Can the patient convey his wishes through gestures or not? Is he trying to eat the soup with a fork or to squeeze out a tube of toothpaste that is still closed? All of these can indicate apraxia.

After taking the anamnesis, the doctor checks certain movement sequences that are often disturbed during apraxia. For example, he will ask the patient to imitate simple hand and finger movements or gestures. He can also ask the person concerned to use a tool (example: "Please show me how to hammer!").

In addition, the doctor checks whether the patient can handle everyday utensils. For example, the person concerned is asked to cut paper with scissors, put on his glasses or open a safety pin.

To clarify a buccofacial apraxia, the doctor tests, for example, whether the person affected can whistle or click their tongue, or whether they are able to blow out a match or use a straw.

Exclusion of other diseases (differential diagnosis)

For a clear diagnosis, the doctor must rule out other diseases that cause symptoms similar to apraxia. These include, for example:

  • Paralysis of the mouth, face, head and / or trunk muscles
  • Ataxia: disorder of movement coordination
  • Neglect: cognitive disorder as a result of a stroke, in which half of the surroundings or of one's own body are not perceived
  • dementia

Apraxia: therapy

An apraxia only requires treatment if the illness hinders the person concerned in everyday life. The therapy focuses on occupational therapy measures.

Relatives, friends and acquaintances should treat patients lovingly and with respect, because their self-esteem often suffers from apraxia. In order to be able to accept the impairments themselves and deal with them in a more relaxed manner, those affected need the greatest possible support from those around them.

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