Ideomotor apraxia: symptoms, causes and treatment

Ideomotor apraxia is a neurological condition that prevents the sufferer from imitating gestures or movements and from performing movements voluntarily and at the request of another person. Patients with this disorder end up having great difficulty carrying out activities of daily living, such as brushing their teeth or picking up cutlery at the table.

In this article we tell you what is ideomotor apraxia, what causes it, the symptoms it causes and the appropriate treatment for this disorder.

    What is ideomotor apraxia?

    Ideomotor apraxia is a neurological disorder that involves the inability to imitate gestures and perform voluntary motor acts, on demand or by verbal command, Due to an error in the configuration, the temporal model and the spatial organization of the members of the body in the context of the movement in question.

    People who suffer from this type of apraxia can spontaneously manipulate tools and objects of daily life, although sometimes this ability is also lost. Deficits caused by ideomotor apraxia appear to result from an interruption or failure of the system that links stored knowledge about the use of everyday objects and information about gestures, with the state of the body to produce the desired or appropriate motor action.

    Ideomotor apraxia causes in patients difficulty performing motor acts and simple movements (Greeting someone or turning off a faucet, for example), as opposed to other more complex motor sequences or movements (like brushing your teeth or getting dressed). However, unlike other apraxias, such as ideation, these people can verbally express these actions.

    It is believed that this system is linked to the areas of the brain that are most often damaged during this apraxia: the left parietal lobe and the premotor cortex of the brain.

    the causes

    Usually the most common cause of ideomotor apraxia is ischemic injury (By losing or stopping blood flow) in one of the hemispheres of the brain. There are several regions of the brain where lesions correlate with this type of apraxia.

    Initially, it was suggested that subcortical white matter lesions treatAxons descending from neural bodies to the cerebral cortex could be one of the main causes responsible for the onset of ideomotor apraxia.

    It has also been pointed out that damage to the basal ganglia, a brain structure responsible for initiating and integrating movement, could be another possible cause, although there is debate today as to whether damage produced only in this region of the brain could be sufficient ideomotor ataxia.

    However, damage to these subcortical brain structures has not been found to be more frequent in patients with apraxia. More recent research indicates that the damaged areas of the brain most associated with patients with this type of apraxia would be: the parietal region, the left premotor cortex, and the supplementary motor area.

    Injury to other types of brain structures, such as the corpus callosum (the bundle of fibers that communicates one hemisphere with another), could also induce apraxical symptoms, with varying effects on both hands. In addition, ideomotor apraxia also occurs concomitantly in Parkinson’s disease, Alzheimer’s dementia, Huntington’s disease, Corticobasal degeneration and progressive supranuclear palsy.

      Signs and symptoms

      Ideomotor apraxia generates a whole series of symptoms which have a varying impact on each individual. Typically, this disorder affects a person’s ability to perform daily movements and actions such as greeting someone, for example.

      The people concerned usually present themselves errors in the way they hold and move tools and objects when trying to use them correctly. One of the most characteristic symptoms of ideomotor apraxia is the inability to perform motor acts under a verbal command. For example, if the patient is given a comb and asks to brush their hair, the hair will perform the movement incorrectly, circling the head or holding the brush upside down.

      The errors made by patients with ideomotor apraxia can be spatial in nature, as in the example of improper use of the comb, and also temporal in nature. Following the example above, the person would perform the act of combing in an excessively slow or erratic manner, showing signs of committing a motor act with errors in the time sequence.

      Another of the most characteristic symptoms of ideomotor apraxia is the inability to imitate hand gestures, whether or not they have special meaning. Patients know what to do when someone asks them to do so, but they cannot perform the gesture correctly. This neurological disorder prevents affected people from performing any voluntary act and sometimes they may even lose the ability to perform spontaneous actions and movements.

      In recent years, several studies have shown that people with ideomotor apraxia seem to be unable to touch their fingers as quickly as a control group of healthy subjects. Additionally, aprax patients are slower to aim at a target light when they cannot see their hand. These people appear to be much more dependent on visual information when making movements than healthy people.

      treatment

      The impact of ideomotor apraxia on the autonomy and functional capacity of the person who suffers from it is variable and generally depends on the other types of associated disorders. The impact of this neurological disorder on activities of daily living is varied.

      Regarding personal hygiene: the person will have serious difficulty in orienting and correctly locating cleaning utensils, such as a comb, toothbrush or razor blade. When it comes to food, the patient will find it difficult to properly grip the cutlery while eating or placing the cutlery on the table, in the correct shape and space. You will also have problems dressing, putting on or taking off socks, for example.

      Although it is known that a small group of patients with ideomotor apraxia recover spontaneously, this fact is not too common. What can happen is the phenomenon of hemispherical compensation, So that the functions normally performed by one hemisphere can be performed by the other, if damaged.

      Occupational therapy and neuropsychological rehabilitation these are the most common treatments in case of apraxia, in order to allow the patient to regain his maximum functional capacity. As a rule, the work is done by dividing the daily tasks into separate components (for example, the act of combing), and the patient learns to perform each motor act individually, and then to complete the entire sequence.

      The above procedure is repeated extensively, so that the person can regain the ability to perform a given movement and possibly combine other sequences to create new and unique movement patterns.

      Bibliographical references:

      • Ardila, A. (2015). Kinetic, ideomotor, ideational and conceptual apraxia. Journal of Neuropsychology, Neuropsychiatry and Neurosciences, Vol. 15, Nº1, pp. 119-139.
      • Sunderland, A .; Shinner, C. (April 2007). “Ideomotor apraxia and functional capacity”. Cortex. 43 (3): 359-367.
      • Wheaton, LA and Hallett, M. (2007). Ideomotor apraxia: a review. Journal of Neurological Sciences, 260 (1-2), 1-10.

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