Apraxia: diagnosis, therapies and prognosis

Apraxia: introduction

The observation of apraxic manifestations, the logical interpretation of the disease and the rational explanation of the concatenation of uncoordinated gestures, often represent enigmatic and obscure elements to decode the intrinsic, hidden meaning of apraxia. In this regard, the diagnosis - essentially based on psychological and motor tests - the therapies aimed at healing the symptoms, and the prognosis, are very problematic, both for the doctor and for the people who live with the apraxic patient, unaware of the disease.

Diagnosis

In the case of apraxia, rather than talking about the actual diagnosis, one should refer to interpretative models based essentially on cognitive tests, useful for assessing the degree of severity of the disease. Typically, the doctor verbally asks the patient to perform certain actions (e.g. whistling, moving the lips, raising the hand, etc.). In case of ascertained aphasia concomitant with apraxia, the cognitive test just described cannot be reliable; in such situations, the test is carried out through the evaluation of gestures that the patient must imitate.
Another diagnostic test is the demonstration of the use of objects: these objects, commonly used in daily life (eg fork, napkin, etc.) are shown to the patient (visual presentation), given in hand (tactile presentation) or mimed (imaginary presentation).
A correct diagnostic evaluation also arises in the observation of the muscles used to carry out an action.
The severity of the brain injury is diagnosed using MRI and computed tomography.
However, it should be remembered that brain injuries do not always involve manifest behavioral deficits; in other cases, the lesions may be so minor that they can be easily resolved with simple targeted tests. A differential diagnosis should be made between apraxia and aphasia, deafness, dementia, blindness, psychological disorders, etc.

Therapies

Physical and occupational therapists, together with speech therapists, represent the reference figures for patients suffering from apraxia. The therapies are essentially based on the rehabilitation of the apraxic subject: we speak of a replacement and restorative approach.
In any case, a specific and exclusive pharmacological therapy, aimed at the definitive resolution of the apraxic symptoms, has not yet been identified; moreover, the quantity of rehabilitation studies carried out for apraxia is rather small. Apraxia is therefore included among the disabling pathologies.

Prognosis

Although apraxia is classified among the disabling neuropathological diseases, some less severe forms tend to resolve spontaneously: this is the case of ideomotor apraxia, for example, where 80% of patients recover without the need for specific rehabilitation or pharmacological treatments.
In case of severity, the prognosis of apraxia is poor: clinical evidence shows that many apraxic symptoms worsen as the patient progresses with age.

Apraxia: reflections

We have seen that apraxia represents a heterogeneous set of movement disorders aimed or not at a purpose. The apraxic motor anomalies do not concern only simple elementary actions: the deficit, in fact, focuses on the programming and coordination of movements, in the concatenation gestures aimed at achieving a precise action and, ultimately, hinders the harmoniousness of the movement, making it clumsy, bizarre and extravagant.
Some texts describe apraxia as one automatic-voluntary dissociation: a given movement, performed correctly in a particular context, is denied during the apraxic tests, because there is no meaning that justifies the action. In this regard, the apraxia proper refers only to those voluntary and learned movements [trait from www.neuropsicologia.it].