🧠 Apraxia is a disorder of learned, voluntary actions resulting from neurological impairment — often overlooked after stroke unless specifically assessed.
📊 Seen in ~1/3 of those in rehabilitation centres and nursing homes following left hemisphere stroke.

📝 Introduction

👩‍⚕️ Motor apraxia after left hemispheric (dominant) stroke → difficulty with daily activities (e.g. making a hot drink).
🥄 Patients may misuse objects (e.g. spoon, toothbrush, razor) or fail to select the correct one at the right time.
📉 Evidence for specific therapies is limited, but recognising apraxia is crucial for supporting recovery, independence, and function.

📌 Definitions

❌ Apraxia = inability to correctly carry out purposeful, skilled actions, not explained by weakness, sensory loss, involuntary movements, or cognitive decline.
🧩 It reflects impaired storage/translation of motor representations in the brain → difficulty linking higher-level action concepts to lower-level muscle activation.
📚 Liepmann’s model: left parietal lobe stores a “space-time form picture” of movement → relayed to frontal engrams → motor cortex → corticospinal tracts. - For right limb: remains in left hemisphere. - For left limb: info must cross via corpus callosum to right motor areas.

🧭 Anatomical Basis

🧠 Localised to dominant (left) hemisphere.
🏷️ Key region: supramarginal gyrus & deep white matter of left parietal lobe.
💬 May co-exist with Wernicke’s aphasia, but also occurs independently.

🔎 Types

💡 Ideational apraxia: loss of the “idea” of movement; impaired conceptual organisation of actions (e.g. cannot pantomime tool use).
⚙️ Ideomotor apraxia: idea intact, but poor translation into motor execution → errors in timing, sequencing, force. Classic error = “body-part-as-object” (e.g. using finger as toothbrush).

🗂️ Subtypes of Apraxia

Form	Definition
💡 Ideational	Loss of concept/plan of action; disrupted sequencing of multi-step tasks.
🛠️ Conceptual	Impairment in tool use concepts → content errors.
⚙️ Ideomotor	Intact idea but poor execution → spatial/temporal errors.
✋ Limb-kinetic	Loss of fine, independent finger movements.
📐 Constructional	Difficulty copying/drawing 3D structures.
👶 Developmental	Dyspraxia in children → organisation & initiation deficits.
👀 Visuo-imitative	Difficulty imitating gestures, esp. meaningless ones.
👄 Oral/Buccofacial	Impaired skilled movements of lips, tongue, cheeks.
👁️ Ocular	Difficulty generating saccades on command.
👕 Dressing	Inability to perform complex act of dressing.
🗣️ Speech apraxia	Articulatory planning disorder → distorted speech.
🖊️ Agraphia apraxia	Impaired writing motor programs despite intact praxis for other tasks.
🚶 Gait apraxia	Impaired coordination of lower limb movements required for walking.
🔄 Callosal	Disconnection apraxia from corpus callosum lesions.
🧩 Sympathetic/Crossed	Unexpected limb apraxia with lesions outside dominant hemisphere.

🧪 Clinical: Screening Tasks

🎭 Pantomime: “Show me how you brush your teeth / hammer a nail / use scissors.”
✋ Gestures: Salute, wave goodbye, hitch a lift.
👄 Buccofacial: Lick lips, blow out a match, drink through a straw.
🧩 Functional: Make a cold drink, put paper in an envelope, file punched sheets.

⚙️ Ideomotor Apraxia Errors

📍 Spatial orientation errors
⏱️ Timing/temporal errors
💪 Force errors
✋ Poor distal differentiation
🤲 “Body-part-as-object” substitutions

💡 Ideational Apraxia Errors

🔀 Wrong object chosen
📉 Sequencing errors (omissions, blends)
⏱️ Action overshoots or remains incomplete
🔁 Perseveration

🩺 Management

👩‍⚕️ Therapy-led assessment → targeted strategies for initiation, execution & control.
🎯 Use of instructions, cues, errorless learning, and task-based practice.
🤝 Multidisciplinary input essential for optimising independence.

📚 References

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Apraxia

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