Apraxia Flashcards
Praxis
ability to conceptualize, plan, organize, and skillfully execute ideas.
A person can engage and perform single step or multi step tasks in environment.
Apraxia
Inability to carry out skilled movement in the presence of intact sensation, movement and coordination.
Dyspraxia
Deficit in execution of learned movement which can’t be accounted for by either weakness, sensory loss, incoordination or inattention to commands
Difficulty conceptualizing, planning, organizing and sequencing sensorimotor action to achieve a goal
What is the problem-apraxia
disturbance in two basic functional cognitive processes
- Planning (purpose), what are we supposed to do. executive functioning
- Execution- Output
what causes apraxia
results from left or right cerebral hemisphere lesions or connections through corpus callosum between left and right sides of brain.
Affects cognitive aspects of motor control
cognitive motor disorder involves the loss or impaired ability to program motor systems to perform purposeful skilled movements.
conceptual planning problems
lack of knowledge of objects and tools in terms of the action and function they serve.
Lack of knowledge or understanding the necessary steps and single actions needed within motor sequence.
Ideational Apraxia
Inability to carry out a previously learned task.
sequence of task in incorrect, errors in end result of task.
-Putting on sock on top of shoes,
-stirs coffee with finger,
attempt to drink juice without opening carton
Production motor planning problems
Difficulty producing movements or sequence of movements to complete the task.
Motor sequencing errors,
Problems imitating movements, and movement production,
Difficulty performing movements upon command.
Common in autism- a neurobiological disorder, could have part or the whole thing. Whole diagnosis of apraxia common.
Ideomotor Apraxia
involves the loss of kinesthetic memory of motor patterns- the motor plan or specific task may be lost (action)
sometimes client cant access specific motor plan on command but can when presented with visual cue such as comb, client is able to perform the actor of combing hair
Difficulty with production errors (motor apraxia), even though the idea and purpose of task is understood.
not knowing what to do with your arm, how to move your arm
awkward or clumsy movements
difficulty orienting body parts to conform to object, difficulty making movements across body’s midline, delay to initiate movement/pauses
functional implications of apraxia
clients can generally spontaneously perform everyday tasks in context but when asked to pantomime or carry out a series of steps- performance is not correct or smooth in execution.
how it affects behavior during meal time and eating
- use of fewer utensils
- less organized with eating
- less efficient
Ideomotor apraxia increases dependency in grooming, bathing, and toileting
Apraxia-aphasia
often occur along one another, making it hard to distinguish between the two (due to left hemisphere brain damage)
Important to check for comprehension of client
May be a language problem and not apraxia
gesture production or use of common object
client is asked to act out a task on command (show me how you comb your hair)
Important to rule out
- problems with sensory function, muscle strength, and dexterity
- assess visual agnosia prior to apraxia testing
- evaluate the clients language status
task performance
observe client movement or sequencing errors while client is performing a task
- how client initiates, executes, and controls movements.
- Does client notice their errors, what is their awareness
observe motors planning skills of both hands
Dressing apraxia
in realm of dressing , same concepts apply
Constructional Disorder
ability to put things together, blocks or Legos.
specific deficit in spatial organization performance
functional limitations: setting a table, making a sandwich, stacking dishwasher, and mechanical tasks in which parts are to be combined into whole.
Apraxia testing methods- gesture to command
includes both transitive (tool use) and intransitive movements (nonverbal communication) more gesture like
Transitive- provide with object and ask
show me how you would open a door with a key, use a hammer”
Intransitive- Ask them to perform limb movements: “show me how you hitchhike, show me how you salute, wave goodbye”
Gesture to imitation
Examiner produces an arm/leg gesture without naming gesture, asks client to “do it the same way I do, don’t start until I am finished (rub hand on belly, wave hand)
Gesture in response to tool/object
visual, shows the tool/subject “show me how you use this”
“show me how you drink a glass of water”
Tactile
Eyes closed or covered, client examines tool by hand and asked to “show me how you use this”
Gesture Comprehension
Examiner makes a gesture and asks client “tell me what I am doing” “what tool am I using” “Am I using a hammer or saw”
Functional methods to assessing Dressing apraxia
Observe client/patient during morning ADL’s- within normal routine and context.
Place shirt, pants, or socks in front of client and ask to show you what one does with object.
Methods of testing constructural disorder
- Use graphic tasks (using copying line drawings and drawing to command)
- Assembly tasks (block and stick designs)
- Copy simple block or geometric designs
Apraxia intervention approaches
- Increase client awareness of problem, teach methods of adapting,
- Have client incorporate affected extremity into activity and verbally acknowledge that his/her left arm and hand is being used.
- Use verbal strategies to aid in recognition
- talking client through sequence of task, chaining the steps of the task, hand over hand assist or light touch
As client uses the limb in occupational tasks, gain perceptual awareness of their body and relationship of body parts to each other.
Intervention approaches- Perform familiar tasks in context, provides visual/object cues, practice
focus on conceptual aspect of motor planning- clients understanding of how tool is used or how a gesture is performed,
- Use mirror for dressing for visual feedback
- Mentally practice or visualize task or sequence prior to performing task.
Adapt task or objects
- Draw attention to features of object/activity (visual or tactile attributes)
- Use written down lists/visuals as reminders
- Tool use- selected with caution
- Adaptive clothing closures
adapt and organize environment
- Set-up of environment and visual cues- objects within space
- Declutter area, organize space for safety
