Motor Perception/Apraxia Flashcards
What is praxis?
The ability to conceptualize, plan, organize, and skillfully execute ideas
The ability to conceive of and plan motor acts in response to the environment
Intact praxis means a person can engage and perform single-step or multi-step tasks in environment
What is apraxia?
In ability to carry out skilled movement in the presence of sensation, movement , and coordination
A deficit in execution of learned movement which cannot be accounted for by either weakness, sensory loss, incoordination or inattention to commands
What is dyspraxia?
Difficulty conceptualizing, planning, organizing, and sequencing sensorimotor actions to achieve a goal
Dyspraxia is inconsistent
What is the specific problem of dyspraxia?
Disturbance of two basic functional cognitive processes that allow us to ac in the world
- Planning: purpose (conceptual)
- Execution: output (production)
Difficulty performing everyday, simple tasks (hair combing, and more complex tasks which require person to use objects and sequence multiple steps to achieve end goal (.g. tying shoes, assembling a puzzle, cooking, placing dishes in dishwasher)
What are motor perception disorders?
- Apraxia results from left or right cerebral hemisphere lesions or connections through corpus callosum between left and right sides of brain
- Predominately left hemisphere lesions of prefrontal lobe, anterior multimodal association area, pre-motor area and/or primary motor cortex
- Affects cognitive aspects of motor control
- This cognitive motor disorder involves the loss or impaired ability to program motor systems to perform purposeful skilled movement
- Interferes with daily living tasks
- Associated with CVA, Alzheimer’s, and TBI
What are conceptual planning problems in apraxia?
- Ideational apraxia is the inability to carry out a previously learned task
- Lack of knowledge of objects and tools in terms of the action and function they serve (ex: when client is asked to perform action of using object/tool, they have difficulty conceptualizing what to do and how to perform task upon command
- Difficulty showing action of object/tool when it is not physically present. Needs contextual cues
- Lack of knowledge or understanding the necessary steps and single actions needed within motor sequence. Can they select objects or steps to perform an action?
What are examples of clinical observations of ideational apraxia?
- Use of familiar objects/tools incorrectly (ex: eats soap, chews on washcloth)
- Multistep tasks (ex: morning grooming routine, self-feeding)
- Performance latency is when client continues a task very slowly
- Does not initiate or perform task at all
What are motor planning problems seen with apraxia?
- Difficulty producing movements or sequence of movements to complete a task
- Motor sequencing errors (occurs as a result of damage to left or right hemisphere)
- Problems imitating movements, and movement production
- Difficulty performing movements upon command
What is ideomotor apraxia?
- Involves the loss of kinesthetic memory of motor patterns. The motor plan for specific task may be lost (action)
- Sometimes the person cannot access specific motor plan on command but can when presented with a visual cue such as a comb. Then the person may be able to perform the act of combing hair
- Difficulty with production errors even though the idea and purpose of the task is understood
What are some clinical examples of ideomotor apraxia?
- Awkward or clumsy movements
- Difficulty orienting hand/arm or foot/leg to conform to object (ex: picking up juice bottle, trying to place foot in slipper)
- Difficulty making movements across midline of body (ex: adjusting grasp of hairbrush when moving brush from one side of the head to the other to brush hair)
- Difficulty orienting hand to conform to object to pick up
- Delay to initiate movement, pauses (timing problem
- Problems sequencing movements (ex: getting out of chair, out of bed, or using a phone
What are functional implications of apraxia?
- Observations of person with apraxia may be subtle or extreme obvious
- Generally, clients can spontaneously perform everyday tasks (e.g. eating, shaving, opening a door) in context
- But when asked to pantomime or carry out a series of steps the performance is not correct or smooth in execution
- Clients have a distorted perception of motor strategies needed to negotiate their environment
- Difficulty performing a series of steps in order or the execution of steps is not smooth or coordinated
How does apraxia affect eating?
- Affects behavior and eating during meal time
- Use fewer utensils
- Less organized with eating
- Less efficient
- Eating is haphazard. Either places to much or too little food on plate or utensil
- Ideomotor apraxia increases dependency in grooming, bathing, and toileting
- Often clients with apraxia become uninterested or apathetic towards a task or activity
Are apraxia and aphasia the same?
No! But apraxia often occurs along with aphasia. This makes it hard to distinguish between the two
- It is important to assess comprehension
What are functional assessment methods for apraxia?
- Traditionally, testing of apraxia consists of gesture production or use of common object
- It is important to perform the following tests to “rule out”:
1) Problems with sensory function, muscle strength, and dexterity before testing for praxis
2) Assess visual agnosia prior to apraxia testing
3) Evaluate the client’s language status
What are clinical observations for apraxia?
- Task performance: observe client movement or sequencing errors while client is performing task
- Observe how the client initiates, organizes, and executes/controls movements
- Which movement is easier? Movements that occur into body or away from body?
- Is performance in correct place or space for movement?
- Does client notice their errors? What is their level of awareness and their response to cueing?
- Observe for the type of apraxia
1) Which body parts are used to carry out verbal and/or imitation commands?
2) Assess motor planning skills of both hands. Are there differences in performance from the left to right hand?
3) Do they use a body part as an object?
