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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.

9 most common cause(s)

Stroke
Brain Tumor
Bacterial Meningitis
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Alzheimer's Disease
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Ataxia-telangiectasia (louis-bar syndrome)
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Subdural hematoma
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Traumatic brain injury
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Cerebral venous thrombosis
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Wernicke-korsakoff syndrome

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Apraxia symptoms

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.

Neurologic causes

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.

Conversion disorder

Rarely, apraxia may be a side effect of severe psychiatric disorder, called a conversion disorder [3].

Metabolic causes

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

Wernicke-korsakoff syndrome

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.

Rarity: Rare

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

Traumatic brain injury

A traumatic brain injury (TBI), or concussion, happens when a bump, blow, jolt, or other head injury causes damage to the brain. This can happen commonly as a result of falls, sports injuries, and car or bike accidents. Every year, millions of people in the U.S. suffer brain injuries. More than half are bad enough that people must go to the hospital, and the worst injuries can lead to permanent brain damage or death.

You should call an ambulance to go to the hospital immediately. There, doctors will examine you and may take images of your head (like a CT scan) to see if there's any bleeding.

Rarity: Common

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

Subdural hematoma

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.

Rarity: Rare

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

Stroke

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.

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

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.

Rarity: Rare

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

Bacterial meningitis

Bacterial meningitis is an infection of the meninges, the layers of membranes that cover the brain and spinal cord. Streptococcus, E. coli, and other bacteria can cause meningitis.

People can carry and spread the bacteria without being infected. The disease can be transmitted through casual contact such as coughing, sneezing, or kissing, or by eating food contaminated with the bacteria.

Most susceptible are infants and young people, especially in group settings such as day cares or dormitories. However, anyone can become infected.

Symptoms escalate quickly and include headache, fever, stiff neck, nausea and vomiting, confused mental status, and sensitivity to light.

Bacterial meningitis can lead to sepsis and permanent brain damage, and is a life-threatening medical emergency. If it is suspected, take the patient to the emergency room or call 9-1-1.

Diagnosis is made through physical examination and spinal tap, to obtain a sample of the spinal fluid.

Treatment involves a course of antibiotics, often during hospitalization.

There are vaccines to protect against bacterial meningitis. Any medical provider can be consulted about obtaining them.

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.

Rarity: Rare

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

Alzheimer's disease

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.

You should visit your physician to discuss these symptoms. It is likely tests will be ordered to better diagnose you.

Rarity: Common

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

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.

Rarity: Common

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

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.

At-home treatment

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.

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The stories shared below are not written by Buoy employees. Buoy does not endorse any of the information in these stories. Whenever you have questions or concerns about a medical condition, you should always contact your doctor or a healthcare provider.
Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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References

  1. Apraxia. National Organization for Rare Disorders. Published 2003. NORD Link
  2. Shelat AM. Apraxia. U.S. National Library of Medicine: MedlinePlus. Updated April 30, 2018. MedlinePlus Link
  3. Singh TD, Duffy JR, Strand EA, Machulda MM, Whitwell JL, Josephs KA. Neuropsychiatric symptoms in primary progressive aphasia and apraxia of speech. Dementia and Geriatric Cognitive Disorders. 2015;39(0):228-238. NCBI Link
  4. West C, Bowen A, Hesketh A, Vail A. Interventions for motor apraxia following stroke. Cochrane. Published January 23, 2008. Cochrane Link
  5. Acquired apraxia of speech. American Speech-Language-Hearing Association. ASHA Link