Apraxia: Adjusting to Life with Apraxia - Common Symptoms & Available Treatments
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Apraxia is defined as difficulty performing tasks that require movement, like riding a bicycle. In apraxia, your brain is unable to formulate that plan effectively.
Once you learn how to throw a ball, hammer a nail, or ride a bicycle, you're unlikely to forget. The brain excels at learning tasks that require movement, and these tasks are mastered easily because the brain can subconsciously and almost instantly coordinate them. Learning these feats happens in the background for most people. However, for people with apraxia, this is not the case.
How apraxia differs among individuals
Apraxia is difficulty performing tasks that require movement due to a problem with planning those movements [1,2]. When you decide to make a move, whether that be picking up a ball or using a hammer, your brain must compute properly to turn thoughts into action. The brain processes signals, and the incoming command, then creates and executes a plan. With apraxia, your brain is unable to formulate that plan effectively. Apraxia can vary, as some people are specifically unable to draw shapes, whereas others may be unable to brush their teeth or walk. If you or someone you know has apraxia, there are activity modifications and resources available to help the brain work around any gaps.
Common characteristics of apraxia
Apraxia may be associated with these common symptoms.
- Cognition: You may be unable to think about doing something.
- Performance: You may be unable to do certain things.
- Stroke symptoms: Other stroke or neurodegenerative symptoms, such as difficulty speaking, paralysis, loss of sensation, cognitive impairment, vision loss, etc., may be present.
Apraxia causes and conditions
Most apraxia is the result of damage to the portions of the brain associated with higher-order motor skills. This damage is usually due to neurodegenerative diseases like dementia or a stroke. Other severe disturbances of the body’s normal, healthy state can lead to apraxia-like symptoms as brain function can be significantly worse when you are severely ill.
When a blood vessel in the brain is blocked off by a clot or when a blood vessel bleeds into the brain, the brain does not receive enough oxygen. Without oxygen, the brain will die within a few minutes. If a stroke occurs in the part of the brain controlling motor skills or the use of tools, this can lead to apraxia.
Neurologic diseases that cause degeneration of the brain, such as dementia, can lead to a variety of issues such as changes in personality, cognition, an inability to speak, or apraxia.
Rarely, apraxia may be a side effect of severe psychiatric disorder, called a conversion disorder .
Metabolic imbalances in the body can impact the brain, leading to apraxia.
- Electrolyte imbalance: Severe imbalance of electrolytes or blood sugar can lead to cognitive deficits.
- Severe infection of trauma: Severe disturbances of your body’s health can lead to various cognitive deficits.
9 possible apraxia conditions
Traumatic brain injury
Traumatic brain injury (TBI) happens when a bump, blow, jolt, or other head injury causes damage to the brain.
Top Symptoms: new headache, irritability, clear runny nose, vision changes, general numbness
Symptoms that always occur with traumatic brain injury: head injury
Urgency: Emergency medical service
Stroke or tia (transient ischemic attack)
Transient ischemic attack, or TIA, is sometimes called a "mini stroke" or a "warning stroke." Any stroke means that blood flow somewhere in the brain has been blocked by a clot.
Risk factors include smoking, obesity, and cardiovascular disease, though anyone can experience a TIA.
Symptoms are "transient," meaning they come and go within minutes because the clot dissolves or moves on its own. Stroke symptoms include weakness, numbness, and paralysis on one side of the face and/or body; slurred speech; abnormal vision; and sudden, severe headache.
A TIA does not cause permanent damage because it is over quickly. However, the patient must get treatment because a TIA is a warning that a more damaging stroke is likely to occur. Take the patient to the emergency room or call 9-1-1.
Diagnosis is made through patient history; physical examination; CT scan or MRI; and electrocardiogram.
Treatment includes anticoagulant medication to prevent further clots. Surgery to clear some of the arteries may also be recommended.
Top Symptoms: dizziness, leg numbness, arm numbness, new headache, stiff neck
Symptoms that never occur with stroke or tia (transient ischemic attack): bilateral weakness
Urgency: Emergency medical service
Alzheimer's disease is a progressive neurological disorder that slowly destroys memory and the ability to think clearly. As symptoms worsen, patients are often unable to perform basic tasks.
Top Symptoms: trouble sleeping, forgetfulness, anxiety, aggression or confusion, anxiety, irritability, depressed mood
Symptoms that always occur with alzheimer's disease: forgetfulness, anxiety, aggression or confusion
Urgency: Primary care doctor
Wernicke-Korsakoff Syndrome, or WKS, is a neurologic disorder. The names represent the acute stage of the illness, called Wernicke's Encephalopathy, and the chronic stage, called Korsakoff Syndrome.
WKS is caused by a deficiency of thiamine, or vitamin B1. It is most often seen in alcoholics; anyone who has had a poor diet, eating disorder, or weight-loss surgery; and those with serious illness such as cancer or AIDS.
Acute symptoms are primarily physical and include abnormal, uncoordinated walking and standing; flickering eye movements called nystagmus; and damage to the heart and nervous system. There may also be profound drowsiness that can lead to coma.
Chronic symptoms are primarily mental and include short-term memory loss and dementia-like behavior.
The acute stages of WKS can be a life-threatening medical emergency. Take the patient to the emergency room or call 9-1-1.
Diagnosis is made through physical examination and blood tests.
Treatment involves simply adding thiamine supplements to the diet, as well as treating any remaining symptoms to aid in recovery.
Top Symptoms: nausea or vomiting, leg numbness, feeling confused and not making sense while talking, amnesia, jerky, unsteady, or uncoordinated walk
Urgency: Hospital emergency room
Meningitis describes inflammation of the meninges, the layers of membranes that surround the brain and spinal cord. Viruses, fungi, bacteria, and other rare causes can lead to meningitis. Streptococcus, Neisseria, Listeria, and Haemophilus are common bacterial causes of mening...
Brain tumor or mass
In medical terms, "mass" and "tumor" mean the same thing: the unexplained, out-of-place growth of tissue anywhere in the body, including the brain.
The cause of any sort of brain tumor is unknown. Some originate in the brain, while others spread from cancers growing in other parts of the body.
Symptoms may include increasing headaches; nausea and vomiting; blurred or double vision; loss of sensation in an arm or leg; loss of balance; confusion; speech difficulties; or seizures.
If symptoms persist, it is important to see a medical provider so that any treatment can begin as soon as possible.
Diagnosis is made through neurological examination, CT scan, and/or MRI.
If the mass or tumor is found to be benign, that means it is not cancer and not harmful. It may or may not be treated.
If it is malignant, that means it is cancer and must be treated. This will involve some combination of surgery, radiation therapy, and chemotherapy, followed by specialized therapy to help with recovery.
Top Symptoms: fatigue, headache, nausea, loss of appetite, irritability
Symptoms that always occur with brain tumor or mass: focal neurological symptoms
Urgency: In-person visit
A subdural hematoma (SDH) is a clot or a pool of blood between the surface of the brain and the dura mater, the brain’s tough outer covering. This is typically due to the stretching and tearing of veins on the brain’s surface. These veins rupture when a head injury suddenly jolts or shakes the brain.
Top Symptoms: headache, new headache, being severely ill, vision changes, lightheadedness
Symptoms that always occur with subdural hematoma: head injury, being severely ill
Urgency: Hospital emergency room
Cerebral venous thrombosis
Cerebral venous thrombosis (CVT,) or cerebral venous sinus thrombosis (CVST) refers to a blood clot in certain veins of the brain.
There are two layers of material that form the lining between the skull and the brain. The occasional open spaces, or sinuses, between these two layers have veins running through them to drain blood and spinal fluid from the brain.
Cerebral venous thrombosis means that a blood clot (thrombosis) has formed somewhere within the veins of these sinuses.
This condition is caused by a congenital malformation in the brain; pregnancy; use of oral contraceptives; meningitis; use of steroids; and trauma to the head.
Symptoms include headache; nausea and vomiting; mental confusion; changes in vision; difficulty walking, moving or speaking; seizures; and coma. CVT is a life-threatening medical emergency. Take the patient to the emergency room or call 9-1-1.
Diagnosis is made through physical examination; CT scan or MRI; blood tests; and sometimes a lumbar puncture (spinal tap.)
Treatment includes anticoagulant medication to destroy the clot, followed by any rehabilitation that may be needed.
Rarity: Ultra rare
Top Symptoms: fatigue, headache, nausea or vomiting, loss of appetite, being severely ill
Symptoms that always occur with cerebral venous thrombosis: being severely ill
Urgency: Emergency medical service
Ataxia-telangiectasia (louis-bar syndrome)
Ataxia-Telangiectasia is a rare, brain degenerative, inherited disease causing disability. Ataxia refers to poor coordination and telangiectasia to small dilated blood vessels.
Top Symptoms: difficulty walking, difficulty with coordination, numbness or tingling sensations in skin, trouble swallowing, jerky, unsteady, or uncoordinated walk
Symptoms that always occur with ataxia-telangiectasia (louis-bar syndrome): difficulty with coordination
Urgency: Primary care doctor
Apraxia treatments and relief
Apraxia is almost exclusively a symptom of severe brain dysfunction — we use tools or manipulate objects with higher-order brain processes. As such, there is very little you can do at home to treat apraxia. The best you can do is adjust the home environment to be most conducive to the affected person’s abilities.
The primary at-home treatment is a home modification. With the assistance of a rehabilitation professional, you should attempt to modify the home environment to be as conducive to everyday living as possible. These changes can help cope with the disabling nature of apraxia.
When to see a doctor
It is likely that you will have to consult a medical professional or team to adjust to living with apraxia.
- Occupational and physical therapy: If the damage to the brain is irreversible, physical and occupational therapy should be obtained to attempt to regain function and to retrain the body to operate with its disability.
- Medications or surgery: Acute stroke can be treated with good outcomes if patients are brought to the hospital and treated with medication or surgery immediately after the onset of symptoms.
When it is an emergency
The symptoms below necessitate medical attention:
- Sudden-onset apraxia
- Stroke-like symptoms
- Progressively worsening neurologic disability
Questions your doctor may ask about apraxia
- Are you experiencing a headache?
- Are you feeling irritable (easily made upset)?
- Are you feeling less alert than normal?
- Do you currently smoke?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Jesse Passman is a PGY-1 surgery resident. He graduated from Rice University with a BS in Ecology and Evolutionary Biology and received his MD from the University of Pennsylvania Perelman School of Medicine. During medical school, Jesse performed work in public health and surgery, taking a year-out to pursue an MPH at the University of Pennsylvania and do research in global surgery and the public health implications and clinical outcomes of trauma. In his free time, Jesse likes to travel, hike, backpack, and cycle.
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- West C, Bowen A, Hesketh A, Vail A. Interventions for motor apraxia following stroke. Cochrane. Published January 23, 2008. Cochrane Link
- Acquired apraxia of speech. American Speech-Language-Hearing Association. ASHA Link