Brain damage can cause different disorders depending on the area affected and its severity.
One of the disorders that causes this is apraxia, having several types depending on the symptoms and the area of the brain affected. Apraxias involve difficulty in making sequential movements.
One of the most famous apraxia is constructive apraxia, In which difficulties are given when making drawings in a detailed and organized way or when assembling objects, which is the subject of this article. Let’s see what it is, what are its causes, symptoms and treatment.
What is constructive apraxia?
Constructive apraxia is a disorder in which difficulty or complete loss of the ability to perform the sequential movements necessary to assemble an object or draw.
Patients diagnosed with this type of apraxia find it difficult to perform everyday actions, such as assembling furniture or drawing a simple drawing on paper.
These difficulties are not the result of motor problems, such as muscle tremors or stiffness, or of visual problems such as blindness. There is no loss of muscle sensation, strength or coordination.
There is also no deficit in understanding what needs to be done, that is, the patient understands the steps to be taken to, for example, assemble a closet. The problem is that it does not perform the sequence correctly and the action is disorganized.
Constructive apraxia can be identified by observing that the patient performs seemingly simple tasks inefficiently and insufficiently such as copying drawings, building figures with blocks or putting together a puzzle.
Constructive apraxia is usually the result of brain injury, Usually in the right hemisphere and more particularly in the parietal and occipital lobes. This injury can be the result of a stroke, head injury, spill, or stroke.
It has long been known that visuoconstructive abilities, that is, those which involve using the path of vision to organize movements to construct objects, they have a bilateral representation in the brain, but there is an asymmetry in their cortical organization. It is the right hemisphere where there is greater specialization in visuoconstructive abilities.
This is not to say that there are no patients with constructive apraxia who present with lesions in the left hemisphere; however, the characteristics are different from those of the correct injury.
When the lesion occurs in the right hemisphere, patients. assessed by trial copying of drawings, they tend to draw in detail, but with difficulty in showing the spatial relationships between parts of the drawing. In contrast, when the lesion occurs in the left hemisphere, the designs are usually less detailed and are copied more slowly and with difficulty when running.
Although lesions of the parietal and occipital lobes are common, frontal lesions can sometimes be seen., And patients injured in this area often have problems with perseverance and planning in the designs.
Depending on the area affected, whether it occurred in the right or left hemisphere, and whether the injury is severe or mild, the symptoms of constructive apraxia vary widely. however, Usually, patients diagnosed with this disorder experience the following symptoms:
- Difficulty or omission of details of the design to be copied.
- When you draw a horizontal line, do it in small pieces
- Rotate, flip, or break numbers.
- Modify the angles of the drawings.
Usually the diagnosis is made by a psychologist or neurologist. The psychologist can administer various tests to know more precisely the characteristics of the constructive apraxia of the patient and the degree of functional impairment. Using neuroimaging techniques, it is possible to find the lesion and its extent, relating it to the severity of what was seen in the patient.
Two types of tests specializing in the detection of constructive apraxia are generally used. On the one hand, there are the assembly tasks, which involves building blocks and assembling two-dimensional and three-dimensional models, such as puzzles, tangram figures or models. On the other hand, and being more and more used, they are drawing tasks, in which the professional orders a certain figure to be copied or verbally instructs the patient to draw something, Like a square, a circle, a cube, among other geometric figures.
Drawing tasks are the most used in practice due to the economical results, as all you need is paper and pens.
The drawing copy tasks not only let us know what the artistic talents of the patient are. They help us see various cognitive aspects, such as visual perception, the ability to differentiate between background and figure, spatial organization, vision-hand coordination. In addition, it allows to observe how planning, memory, sequencing and attention are given.
Among the most used drawing tests we find the intricate figure of Rey and proof of the clocks copy. The first consists of a figure without semantic meaning, that is, a very complex abstract drawing, while the second is the simple copy, either with a model or verbally, of a clock, which the patient knows already in advance. .
The treatment for this type of apraxia is usually done through motor therapy and insisting that it be fixed in more detail in the parts of the drawing. however, the best option is to intervene directly on the focus of the disorderThat is, about the injury, either surgically or medically. Complete healing of apraxias does not usually occur, although this depends on the location and severity of the injury.
It is very important that the family is involved in the recovery and providing emotional support to the patient with this type of disorder so that they can undergo therapy and improve.
The particular case of apraxia of the
Although it has traditionally been linked to constructive apraxia, dressing apraxia has a number of peculiarities that differentiate it.
This type of apraxia has been linked to an alteration in the figure and a deficit in the movements necessary for dressing. however, is to differentiate itself from constructive apraxia since the problems are only linked to the acts of dressing., And not in other areas like figure coupling or copying apraxia designs explained in depth in this article.
Patients with apraxia of dress significantly affected their autonomy: they put their clothes in the wrong order (for example, the jacket before the shirt), often manage to put the clothes on after several trial and error and more complex actions, such as tying the shirt or lacing up shoes, are real odysseys.
This type of apraxia may be accompanied by constructive apraxia and has been linked to damage to the temporoparietal cortex of the right hemisphere and the anterior cingulate cortex.
- García, R. and Perea, MV (2015). Constructive and dressed apraxia. Journal of Neuropsychology, Neuropsychiatry, and Neurosciences, 15, 1, 159-174.
- Greene, JDW (2005). Apraxia, agnosia and abnormalities of visual function. Journal of Neurology, Neurosurgery and Psychiatry; 76: v25-v34.