Ideational apraxia: definition, causes and symptoms

Ideational apraxia is a neurological condition that prevents a person from thinking and performing certain sequences of movements. with everyday objects and tools, when asked to do so.

For example, when we tell a patient with this type of apraxia to communicate aloud the steps necessary for brushing their teeth, it will be impossible.

Next, we will see in more detail what ideational apraxia is, what are its causes and their main symptoms, as well as the indicated treatment.

    What is ideational apraxia?

    Ideational apraxia is a neurological disorder characterized by the loss of the ability to conceptualize, plan, and execute. the complex sequences of motor actions involved in the use of everyday tools and objects.

    This condition prevents the subject suffering from it from planning movements in which there is some kind of interaction with the objects, due to the fact that there is a loss of knowledge or perception of their purpose. Characteristics of this disorder include an altered concept of the sequential organization of voluntary actions. The patient seems to have asked to know what a specific object represents.

    It was psychiatrist Arnold Pick who a century ago described the first patient to appear to have lost the ability to use objects; this person has made mistakes such as combing the wrong side of the comb or brushing their teeth with their finger, mistakes that often occur in ideational apraxia.

    However, it was not until the 1900s that German neurologist Hugo Liepmann redefined the term ideational apraxia, specifically describing a number of disorders that primarily involved problems with motor planning, aside from alterations in perception. visual, language or symbolism of the patients. capacity.

    the causes

    The causes of ideational apraxia are still unknown to most researchers.

    however, studies in patients with brain damage indicate that this type of apraxia is linked to damage to the dominant hemisphere, In areas similar to those associated with disorders such as aphasia.

    It was Liepmann at the beginning of the last century who proposed a hypothesis involving a motor processing system, responsible for performing actions, located in the left cerebral hemisphere and responsible for the motor planning that guides the movements of the body. However, he was never able to describe in two patients with the same brain lesions the same type of symptoms typical of ideational apraxia.

    Other researchers have pointed out that possible damage to the lateral groove of the brain, also known as the Silvio’s cleft, could help explain the deterioration in object recognition by subjects. Another possible location that would lead to the typical symptoms of ideational apraxia could be the marginal rotation, located in the parietal lobe of the brain.

    In general, ideational apraxia has been identified with bilateral lesions in the parietooccipital and parietotemporal regions, although frontal and frontotemporal lesions of the left hemisphere have also been proposed as possible localizations involved in the causes of this type of apraxia, because this would explain the problems of motor planning observed in this type of patient, as well as the difficulty in distinguishing it from certain aphasias.

    In cases where apraxia occurs with a certain type of dementia (Alzheimer’s or Parkinson’s), extensive injuries to the left hemisphere and damage to the corpus callosum have been described.

    Signs and symptoms

    Patients with ideational apraxia, as discussed above, are unable to perform movements that involve an orderly sequence of acts. Although the person may be able to perform each act of those who make up a movement separately, he cannot perform it in an orderly and logical manner.

    To verify this, Liepmann performed a series of tests, called multi-object tasks. Each task requires the patient to use more than one object; the researcher describes the task to the patient and asks him to perform this task as described. Liepmann gave the patients several items, such as a candle, a wick and a box of matches. He then watched to see how they interacted with each object.

    In the case of the matchbox, one of the patients brought the box closer to the wick side; another, he opened the box and took out a lamp, and brought it to the wick without lighting it; another patient knocked the candle against the matchbox, and so on. The researcher was able to observe the discontinuity of patients’ actions in relation to everyday objects, categorizing the errors they made, such as: misplacement of actions, misuse of objects, omissions or sequential errors.

    In short, the deficit presented by patients with ideational apraxia is not knowing how to use an object because they fully understand the function of each one. The problem is that when they try to interact with multiple objects to perform one of their functions, the execution becomes faulty..

    The person is therefore capable of performing more or less complex actions in a routine manner (lighting a lamp or opening a box), but cannot do it under a verbal command or when asked to do so. For this reason, for some researchers, this type of apraxia is nothing more than severe ideomotor apraxia, which involves the inability to perform movements or gestures when these are requested verbally or by imitation. .

    treatment

    Currently, the most common treatment for ideational apraxia, which is always a brain disorder, is occupational therapy and neuropsychological rehabilitation., Which aim to slow the progression of symptoms and help patients regain their independence and functional autonomy.

    In younger patients, after a stroke causing such apraxia, recovery is less complicated because their brains are more plastic than that of an adult or an elderly person, so new patterns and behaviors develop. during rehabilitation, functioning and intact neural areas may take over some of the functions performed by damaged areas.

    Ideational apraxia has been frequently described in Alzheimer’s dementia, being a major cause of morbidity and progressing more with the underlying disease. In these contexts, people quickly lose their autonomy and become very dependent, being necessary to use technical aids and, in the most serious cases, to be transferred to a center where they can cover their needs.

    Bibliographical references:

    • Ardila, A. and Rosselli, M. (2007). Clinical neuropsychology. Editorial El Manual Modern.

    • Hanna-Pladdy, B. and Gonzalez Rothi, LJ (2001). Ideological apraxia: confusion that started with Liepmann. Neuropsychological rehabilitation, 11 (5), 539-547.

    • Ochipa, C., Rothi, LJ G and Heilman, KM (1989). Ideational apraxia: a deficit in the selection and use of tools. Annals of Neurology, 25, 190-193. doi: 10.1002 / ana.410250214

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