Apraxia

As apraxia ( gr άπραξία " inaction " ) refers to a disorder of the execution of arbitrary focused and orderly movements in intact motor function. There is neither paralysis nor ataxia. Involuntary movements can be carried out coordinated. This affects the facial expressions ( apraxia of the face), the language ( apraxia of speech organs ) and / or the gestures or the use of tools (limb apraxia ).

Causes of this disorder are brain damage usually the language-dominant cerebral hemisphere ( at 95 % of right-handers and 70% of left-handers this is always the left hemisphere ). The most common cause is a stroke; may be other important causes but also brain tumors, dementia, multiple sclerosis, encephalitis, or alcoholism.

Classification of apraxia

The distinction between the different forms of apraxia is controversial and here follows the systematic classification of 1908 Hugo Liepmann. The rough classification can be done in motor and visual- constructional apraxia; the motor apraxia can be further divided into ideomotor apraxia and ideational. The motor apraxia usually occur after damage to the language-dominant hemisphere, while the visual- constructional apraxia is observed in more damage to the non- language-dominant side.

Ideomotor apraxia

→ Main article: Ideokinetische apraxia

The ideomotor apraxia, also called ideokinetische apraxia, usually occurs with damage to the language-dominant hemisphere. The exact location of the damage is either the motor association centers and / or in the connecting fibers thereof, and / or the commissural joining the hemispheres.

There will be false expressive movements and gestures. Expressions are used incorrectly. Treatment processes can not be imitated. Visible is this Apraxia form especially when prompted to mime imitating, for example, in physiotherapy. On the other hand there is perseverations. The person keeps repeating the same action sequences, which he has collected once.

The more damage towards the crown tends to result in a limb apraxia with preservation of gestures. The lesion in the left frontal lobe has more of a buccofaziale (face and facial expressions in question ) apraxia result, whereas limb movements tend to have fewer deficits.

Through sensory feedback often can provide good compensation. The implementation of physiotherapy, occupational therapy and speech therapy, if appropriate, is crucial for a favorable course of therapy.

Ideational apraxia

The ( rare ) ideational apraxia also occurs mostly in damage to the language-dominant hemisphere. The exact location of the damage is located in the temporo -parietal association cortex.

It is believed a faulty plan of action, which makes it impossible for the patient to put together individual movements to action. The casualty seems to be the sense of individual actions are not to be clear why they can not initiate movements or cancel immediately.

Despite completely intact muscles and movement coordination sufferers are unable to pull a key from his pocket and put it into a keyhole. The person tries for example, first something to put into the keyhole, then searches for the key, but finds the bag is not so patient with this disorder are often not able to dress properly, and pull for example, the underpants on the road pants.

The disorder is very relevant to everyday life and leads to a significant impediment. Especially in this case, the implementation of physiotherapy, occupational therapy and speech therapy, if appropriate, for a reasonable course of therapy is crucial.

Constructional apraxia

This apraxia occurs mostly in damage to the non- language-dominant hemisphere. The exact location of the damage is in the parietal association cortex at the site of visuo -motor link.

It comes to the inability to detect and trace geometrical figures correctly.

Other forms of apraxia

This list is not checked for completeness.

• Bukkofaziale apraxia and apraxia of speech: The apraxia of facial muscles ( bukkofaziale apraxia ), besides coordination deficits of facial muscles also lead to a disturbance of arbitrary eyes circuit ( Lidapraxie ).

Disorders of the programming of speech movements are referred to as apraxia of speech. The apraxia of speech (English Apraxia of Speech ) usually occurs in conjunction with aphasia on (especially in so-called Broca 's aphasia [ in older literature also referenced as " motor aphasia " ] ).

The causes are varied as in aphasia. Mostly are cerebro- vascular disorders ( circulatory disorders ) or traumatic effects ( bleeding, accidents, surgical trauma).

In apraxia of speech is observed disturbances in the areas of articulation ( segmental symptoms), prosody ( suprasegmental symptoms) and speech behavior. Be differentiated ( differential diagnosis) is the apraxia of speech from aphasic - phonological disorders and dysarthria.

The treatment for apraxia of speech occurs, for example in clinical speech scientists / linguists, speech pathologists and other therapists.

Research from linguistics ( Patholinguistics, psycholinguistics, phonetics ... ) aim to design models of the exact structure and organization of the speech process. Currently, there are few to no science-based treatment approaches for apraxia of speech.

• Frontal Gangapraxie: Sufferers stumble over their own feet, walking legs and insecure. If you then give them a light guide, for example, by a tool such as a walker, they often extend almost normal.
• Link Kinetic apraxia
• Gliedapraxie
• Tactile apraxia
• Visuo -motor apraxia

General symptoms of apraxia

Typical of apraxic disorders are clumsy ausprobierende movements. Sufferers have difficulty distinguishing between the objects and their own body parts. Try, for example, held the key to stick their finger in the keyhole or instead of the toothbrush to brush your teeth with your finger.

Reflex movements, long semi-skilled movements such as handshakes, expressive movements such as laughing and crying and associated movements such as the resonance of the arms when walking, usually remain.

Historical

Already in the 19th century, the term apraxia was used by the English neurologist John Hughlings Jackson. Hugo Liepmann systematized the various forms of apraxia in the early 20th century. Since then, a distinction between the motor ( ideomotor and ideational ) apraxia and constructional apraxia.

References and Literature

• Neuropsychological syndrome
• Disease symptom in neurology