Apraxia Essay Sample
Apraxia is a rare condition, which is usually caused by damage to the parietal or frontal lobe. The memory of the sequence of movements required to perform complex actions is violated. At the same time, there are no physical defects, which can prevent a person from actions. For example, buttoning the buttons actually consists of a series of motions, but people suffering from apraxia cannot perform them in the correct sequence. Therefore, apraxia is the inability to perform actions that require memorizing a particular sequence of movements.
Apraxia is characterized by the fact that despite the strength in the extremities and safety of elementary motor acts, there is the violation of the ability to perform quite delicate purposeful movements and actions. “As a first approximation, apraxia can be defined as a disturbance of the mental control of deliberate motor actions” (Goldenberg, 2013, p. 1). Apraxia combines various forms of the violation of actions. “During the last century, it has been used to describe a wide variety of neurologically included, acquired, and developmental disorders including buccofacial apraxia, speech apraxia, constructional apraxia, dressing apraxia, gait apraxia, gaze apraxia, and swallowing apraxia” (Rothi & Heilman, 1997). As a result, there are several classifications of the disease. The best-known one was proposed by Alexander Luria. He developed a classification of apraxia on the basis of a common understanding of the psychological structure and the brain organization of an arbitrary motor act. He identified four forms of apraxia, namely, kinesthetic afferent, kinetic, constructional, and regulatory apraxia.
Kinesthetic apraxia occurs in lesions of the parietal lobe, near the postcentral gyrus. With the violation of the left hemisphere, apraxia has a bilateral character. However, if the right hemisphere is damaged, it is manifested only in the left hand. The main defect is the violation of the proprioceptive kinesthetic afferent motor act in the preservation of the outer space organization of movements. Because of the brain damage, motions become undifferentiated and poorly controlled. Patients lose the ability of the right reproduction of various postures of hands. It is difficult to perform actions without objects. For example, it is hard to show how water is poured into a glass.
Constructional apraxia occurs in lesions of the parietal-occipital cortex at the border of the 19th and 39th fields, especially in lesions of the left hemisphere or bilateral foci. At the heart of this form of apraxia, there is the violation of visual-spatial synthesis and spatial representations. Thus, patients suffer from visual-spatial afferentation in movements. Constructive apraxia is a specific and common form of the violation of praxis, which mainly concern the construction of details and figures of a drawing. Patients find it difficult or cannot copy simple geometric figures, objects, animals, and human figures directly or from memory. The contours of an object are distorted. For example, a person draws an oval instead of a circle. It is especially difficult to copy complex geometric shapes, for example, a five-pointed star or a rhombus. Difficulties do not only occur in drawing, but also in the construction of figures from sticks (matches) or cubes according to a given sample. Disorders of constructive praxis appear very clearly when copying unfamiliar figures without a verbal designation. This technique is often used to detect hidden disorders of constructive praxis. A typical manifestation of the latter is also difficulties in choosing a place to draw on a sheet of paper.
One more form of apraxia is kinetic, which is associated with damage to the lower divisions of the premotor area of the cerebral cortex. It is included in the premotor syndrome. Kinetic apraxia is connected with violations of the automation of different mental functions. This type is manifested in the form of the decay of “kinetic melodies”, the violation of the temporal organization of motor acts. At the same time, there are simple motor perseverations manifested in the uncontrolled continuation of a movement once started, especially serially performed.
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In regulatory apraxia, the lesion focus is localized in the region of the convexital prefrontal cortex anterior to the premotor areas. It proceeds as a result of the preservation of muscle strength and tone. At the heart of the disease, there is the violation of the arbitrary monitoring of movements, as well as the speech regulation of motor acts. It is manifested in the form of disorders in programming motions, disconnection of conscious control over the ones, and replacing of the right movements with motor patterns and stereotypes. There are system perseverations of the entire motor program. The greatest challenges for the patient are a change in driving programs and actions. In case of a breakdown of an arbitrary regulation of movements in patients, there are symptoms of echopraxia in the form of an imitative repetition of movements of the experimenter (Magill, 2011).
In addition, there is verbal apraxia, which occurs because of violations of the brain regions responsible for the control of speech. In case of this disease, a patient knows what he/she wants to say, but is physically unable to utter a few words or sounds. Nevertheless, a person understands other people’s speech perfectly. Verbal apraxia is a congenital disease, which appears in early childhood. “Childhood apraxia of speech is a condition that is estimated to occur in about one to 10 children per 1.000” (Velleman, 2003). Apraxia can also be an independent disease or observed together with other neurological disorders. If it is motor apraxia, it consists in the loss of coordination of individual limbs.
Today there are several major reasons that explain the emergence of apraxia. The main one is the brain damage that occurs because of injuries. Apraxia can be also caused by a heart attack, myocardial tumors or traumas, or the degenerative process with the localization of lesions usually in the parietal lobes or associated parts, where the programs of actions learned during life are stored. Less commonly, apraxia damages other parts of the brain (the premotor cortex, corpus callosum, or the frontal lobe) or causes diffuse processes, particularly, degenerative dementia.
In the process of examination, the doctor asks the patient to perform or repeat familiar motor acts. In parallel, the former checks the muscle strength in all muscle groups involved to avoid muscle weakness or paresis as a reason for existing disorders. The neuropsychological research, as well as information from the physiotherapist and occupational therapist, enables to identify more complex options of apraxia. The doctor should ask the relatives of the patient about the extent to which the latter can perform daily activities (for example, using cutlery, toothbrushes, utensils for cooking, a hammer and a pair of scissors) and discover whether the patient can write without assistance. CT or MRI (with or without angiography) helps clarify the presence and the nature of lesions (heart attack, hemorrhage, mass effect, and focal atrophy). A physical examination usually reveals the main neuromuscular diseases or injuries that can be confused with apraxia.
Methods of treating apraxia depend on many different factors. The doctor takes into account the age of the patient, and the nature and extent of a lesion. In general, nowadays, there is no specific treatment. Nevertheless, physical and occupational therapy can contribute to functional recovery significantly. It is necessary to take into account the fact that the drugs used to inhibit the progression of dementia resulting from apraxia are not effective. After applying physiotherapy, the basic functions of the body improve, and the patient’s life becomes safer.
It is worth noting that apraxia is expressed through an impaired ability to move, and if motor skills are also damaged, the patient cannot even pour a cup of tea. Apraxia in children is especially difficult to treat as there is no opportunity to acquire necessary skills. Therefore, the treatment of apraxia is a long and difficult process, which will require patience and persistence. Having the first suspicions of apraxia, it is necessary to see a neurologist or psychiatrist. What expert is required will depend on the cause and type of violations. In most cases, the patient with apraxia is prescribed individual therapeutic programs, namely, labor training, physiotherapy and work with a speech therapist. It should also be noted that patients with apraxia need constant care and concern. Therefore, they require a social worker, psychologist, and a nurse, as a person becomes disabled for a certain period of time. A struggle for improving health is extremely long and difficult (Tanner, 2010).
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In conclusion, apraxia is the inability to perform purposeful, habitual for the patient motor acts despite the lack of primary motor defects. This effect is caused by the brain damage. A diagnosis is based on clinical symptoms, neuropsychological and imaging data (CT, MRI) studies. The prognosis depends on the nature and extent of damage, as well as the patient’s age. Specific treatment is not developed. However, physiotherapy and occupational therapy may accelerate functional recovery.