Apraxia
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{{DiseaseDisorder infobox |
Name = Apraxia |
ICD10 = {{ICD10|R|48|2|r|47}} |
ICD9 = {{ICD9|438.81}}, {{ICD9|784.69}} |
ICDO = |
Image = |
Caption = |
OMIM = |
OMIM_mult = |
MedlinePlus = 003203 |
eMedicineSubj = neuro |
eMedicineTopic = 438 |
DiseasesDB = 31600 |
MeshID = D001072 |
}}
'''Apraxia''' is a [[neurological disorder]] characterized by loss of the ability to execute or carry out learned purposeful movements, despite having the desire and the physical ability to perform the movements. It is a disorder of motor planning which may be acquired or developmental, but may not be caused by incoordination, sensory loss, or failure to comprehend simple commands (which can be tested by asking the person tested to recognize the correct movement from a series). Apraxia should not be confused with [[aphasia]], an inability to produce and/or comprehend language, or [[abulia]], the lack of desire to carry out an action.
The root word of '''Apraxia''' is ''praxis'', [[Greek language|Greek]] for an act, work, or deed. It is preceded by a [[privative a]], meaning 'without'.
==Types==
There are several types of apraxia including:
* ''ideomotor'' (inability to carry out a motor command, for example, "act as if you are brushing your teeth" or "salute") - the form most frequently encountered by [[physician]]s,
** ''limb apraxia'' when movements of the arms and legs are involved,
** ''nonverbal-oral'' or ''buccofacial'' (inability to carry out facial movements on command, e.g., lick [[lips]], [[whistle]], [[cough]], or [[wink]]),
* ''ideational'' (inability to create a plan for or idea of a specific movement, for example, "pick up this pen and write down your name"),
* ''limb-kinetic'' (inability to make fine, precise movements with a limb),
* ''verbal'' (difficulty planning the movements necessary for [[Speech communication|speech]]), also known as Apraxia of Speech (see below)
* ''constructional'' (inability to draw or construct simple configurations),
* ''oculomotor'' (difficulty moving the [[eye]])
Each type may be tested at decreasing levels of complexity; if the person tested fails to execute the commands, you can make the movement yourself and ask that the person mimic it, or you can even give them a real object (like a tooth brush) and ask them to use it.
Apraxia may be accompanied by a [[language disorder]] called [[aphasia]].
===Apraxia of speech===
Childhood Apraxia of Speech (CAS) presents in children who have no evidence of difficulty with strength or range of motion of the articulators, but are unable to execute speech movements because of motor planning and coordination problems. This is not to be confused with phonological impairments in children with normal coordination of the articulators during speech.
Symptoms of Acquired Apraxia of Speech (AOS) and Childhood Apraxia of Speech (CAS) include inconsistent articulatory errors, groping oral movements to locate the correct articulatory position, and increasing errors with increasing word and phrase length. AOS often co-occurs with Oral Apraxia (during both speech and non-speech movements) and Limb Apraxia.
==Causes==
Ideomotor apraxia is almost always caused by lesions in the language-dominant (usually left) hemisphere of the [[brain]], and as such these patients often have concomitant [[aphasia]], especially of the [[Expressive aphasia|Broca]] or [[Conduction aphasia|conduction]] type. Left-side ideomotor apraxia may be caused by a lesion of the [[anterior]] [[corpus callosum]].
Ideational apraxia is commonly associated with confusion states and dementia.
==Treatment==
Generally, treatment for individuals with apraxia includes [[physical therapy]], [[occupational therapy]] or [[speech therapy]], and [[IVIG]].
==Prognosis==
The prognosis for individuals with apraxia varies. With therapy, some patients improve significantly, while others may show very little improvement. Some individuals with apraxia may benefit from the use of a [[Augmentative and alternative communication|communication aid]].
==References==
*{{cite book
| last = Epstein
| first = O.
| authorlink =
| coauthors = D. Perkin, J. Cookson, D.P. de Bono
| title = Clinical Examination
| publisher = Mosby
| date = 2003
| location = London
| pages = 294
| url = http://www.fleshandbones.com/bookshop/title.cfm?ISBN=0723432295
| doi =
| id = ISBN 0-7234-3229-5 }}
* Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. ''Harrison's Principles of Internal Medicine''. New York: McGraw-Hill, 2005. ISBN 0-07-139140-1.
{{Speech and voice symptoms and signs}}
[[Category:Neurological disorders]]
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