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Apraxia

What Is It, Causes, Signs and Symptoms, and More

Author:Anna Hernández, MD

Editors:Alyssa Haag,Emily Miao, PharmD,Kelsey LaFayette, DNP, RN, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:Stacy Johnson, LMSW


What is apraxia?

Apraxia is a neurological disorder characterized by the inability to carry out purposeful movements and gestures. People with apraxia typically have difficulty performing everyday tasks such as getting dressed, buttoning a shirt, grooming, cleaning, and using kitchen utensils. In some cases, apraxia may affect the individual’s speaking ability, even though their comprehension and communication are not affected. Apraxia can have a negative impact on the individual’s independence and negatively affect their quality of life.

Man unable to purposely walk or stand.

What causes apraxia?

Apraxia typically occurs due to an injury to the areas of the brain that control the learned movement patterns, including the parietal and premotor cortex. Common causes of apraxia include cerebral vascular disease (e.g., stroke), neurodegenerative disorders, including Parkinson and Alzheimer disease, as well as other forms of dementia, like corticobasal degeneration. Less common causes include congenital conditions (e.g., Rett syndrome), brain tumors, or a traumatic brain injury

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What are the signs and symptoms of apraxia?

The main symptom of apraxia is the inability to carry out skilled or learned movements without any primary motor or sensory dysfunction. In some cases, apraxia may be accompanied by aphasia, a communication disorder affecting the individual’s ability to formulate or comprehend language. 

There are several forms of apraxia, which may occur alone or together. The most common is buccofacial or orofacial apraxia, which is the inability to perform facial and lip movements, such as licking lips, whistling, coughing, or winking. This form includes apraxia of speech, which is the inability to coordinate the mouth and tongue movements necessary for speech production. Symptoms of apraxia of speech include having difficulty moving smoothly from one sound, syllable, or word to another; groping movements with the jaw, lips, or tongue to make the correct movement for speech sounds; difficulty imitating simple words; and voicing errors, such as saying "chicken" instead of "kitchen."

 Ideomotor apraxia, on the other hand, refers to the inability to imitate a gesture or make the proper movement in response to a verbal command. For example, individuals with ideomotor apraxia may be able to pick up a phone automatically when it rings. Still, they may not respond appropriately to the command “pretend to answer the phone.” 

Next, ideational apraxia refers to the inability to coordinate activities involving multiple, sequential steps or objects, such as dressing, eating, or cleaning. These individuals may complete actions in an incorrect order, like putting the shoes on before socks or frying an egg without turning on the stove. They may also use the wrong tool or object to perform a given task (e.g., trying to comb their hair with a toothbrush). This is different from limb-kinetic apraxia, which is the inability to carry out fine, precise movements with the arm or leg, such as using a screwdriver or zipping a jacket. 

Other forms of apraxia include constructional apraxia, the inability to copy, draw, or construct simple figures, and oculomotor apraxia, which refers to difficulty moving the eyes on command.

How is apraxia diagnosed?

Diagnosis of apraxia is often challenging due to the many different types of apraxia, the various definitions used to describe it, and a lack of standardized assessments. Since apraxia is typically a symptom of an underlying disease, initial diagnosis includes obtaining a thorough history and physical exam and additional diagnostic tests to find out the cause. Health professionals can assess apraxia in several different ways, such as using self-report questionnaires, observing the individual’s behavior when imitating gestures or following spoken commands, and interviewing the individual and their family members about performance in everyday activities.

How is apraxia treated?

Treatment of apraxia depends on the underlying cause and the severity of the condition. While there are no specific treatments to cure apraxia, individuals with neurodegenerative disorders may benefit from medications to slow down the underlying disease process.

In addition, individuals with apraxia may benefit from supportive care, including speech therapy, occupational therapy, and physical therapy, depending on the form of apraxia. Speech therapy is conducted by speech-language pathologists specializing in diagnosing and treating speech and language disorders. Speech therapy focuses on helping individuals produce speech sounds by helping their muscles and tongue move correctly. In cases where the individual’s ability to speak is severely impaired, individuals may be able to use other forms of communication, including hand gestures, writing, pointing to letters or pictures, or using a computer, which is called augmentative and alternative communication. On the other hand, physical and occupational therapy may help individuals become more independent in their everyday life. 

What are the most important facts to know about apraxia?

Apraxia is a neurological disorder characterized by the inability to perform purposeful movements and gestures despite having the desire and the physical ability to do so. It may interfere with everyday activities such as dressing, grooming, or eating and may also affect one’s ability to speak. Common causes of apraxia include stroke and neurodegenerative disorders, such as Parkinson or Alzheimer disease. Currently, there’s no specific treatment to cure apraxia. However, speech, physical, and occupational therapy can help improve quality of life.

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Related links

Nervous system anatomy and physiology
Anatomy of the cerebral cortex
Stroke: Clinical practice

Resources for research and reference

Greene, J. D. W. (2005). Apraxia, agnosias, and higher visual function abnormalities. Journal of Neurology, Neurosurgery & Psychiatry, 76(suppl_5), v25–v34. doi:10.1136/jnnp.2005.081885

Grigor’eva, V. N. (2017). Classification and Diagnosis of Apraxia. Neuroscience and Behavioral Physiology, 47(3), 266–274. doi:10.1007/s11055-017-0392-4 

Park J. E. (2017). Apraxia: Review and Update. Journal of Clinical Neurology (Seoul, Korea), 13(4), 317–324. https://doi.org/10.3988/jcn.2017.13.4.317

Wheaton, L. A., & Hallett, M. (2007). Ideomotor apraxia: A review. Journal of the Neurological Sciences, 260(1-2), 1–10. doi:10.1016/j.jns.2007.04.014