apraxia

apraxia

Disturbance in carrying out skilled acts, caused by a lesion in the cerebral cortex; motor power and mental capacity remain intact. Motor apraxia is the inability to perform fine motor acts. Ideational apraxia is loss of the ability to plan even a simple action. In ideokinetic apraxia, there is no coordination between formation of ideas and motor activity; affected persons can do certain things automatically but not deliberately. Constructional apraxia is the inability to put together elements to form a meaningful whole.

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apraxia [ā′prak·sē·ə]

(medicine)

The inability to perform purposeful acts as a result of brain lesions; characteristically, paralysis is absent and kinesthesia is unimpaired.

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Apraxia

An impairment in the performance of voluntary actions despite intact motor power and coordination, sensation and perception, and comprehension. The apraxic person knows the act to be carried out, and has the requisite sensory-motor capacities, yet performance is defective. The abnormality is highlighted when the act must be performed on demand and out of context. Defects in performance vary from total inability to initiate the action, to incorrect serial ordering of elements, to partial approximations. A common apraxic behavior is the use of a body part as an object. Pantomiming the act of brushing the teeth, for example, a person may run the index finger across the teeth as though it were a toothbrush, while in normal performance, the hand assumes the posture of holding and moving the brush.

Apraxia is usually observed in both upper extremities. When it occurs unilaterally, it is usually the left arm and hand that are affected. This has been explained by assuming that the left cerebral hemisphere is specialized in the organization of voluntary movements, just as it is in language. The left hand is under the immediate control of the right hemisphere, but for skilled voluntary actions, the right hemisphere is dependent on information transmitted from the dominant left hemisphere over the corpus callosum. Callosal lesions produce apraxia of the left hand, because the right hemisphere is incapable of organizing the plan of movement independently. With an appropriately placed left-hemisphere lesion, a bilateral apraxia will result. When the left-hemisphere lesion also destroys the primary motor zone, the right arm is paralyzed and the apraxia is masked. The observable apraxia on the left side is referred to as sympathetic apraxia. This is seen in many individuals with right hemiplegia (unilateral paralysis of the body) and Broca's aphasia. Another apraxia often coupled with Broca's aphasia is nonspeech oral apraxia (or buccofacial apraxia). Individuals with this disorder can be observed to struggle to perform such simple acts as protruding the tongue or licking the lips on command or imitation, even though these movements are executed easily as part of the act of eating. See Aphasia, Hemispheric laterality

There are several disorders that are controversial with regard to their interpretation as forms of apraxia. The nonfluent speech pattern of Broca's aphasia, often riddled with speech-sound errors, is considered as apraxia of speech by some authorities, while others view it as an integral part of the linguistic deficit of the aphasia. In dressing apraxia and in some types of constructional apraxia, the defect appears to be perceptually based. Limb-kinetic apraxia is widely interpreted today as a mild spastic paresis, while ideational apraxia, commonly associated with dementia, is likely due to conceptual confusion rather than to a disturbance of motor organization. See Agnosia