Ideomotor apraxia: symptoms, causes and treatment

Ideomotor apraxia is a neurological condition that causes a disability in the person who suffers from it. to imitate gestures or movements, and to perform movements voluntarily and at the request of another person. Patients with this disorder end up having great difficulty carrying out activities of daily living, such as brushing their teeth or correctly picking up the cutlery at the table.

In this article we explain what is ideomotor apraxia, what are the causes that explain it, the symptoms it causes and the appropriate treatment for this disorder.

• Related article: "The 5 types of Apraxia: differences, symptoms and frequent causes"

What is ideomotor apraxia?

Ideomotor apraxia is a neurological disorder that involves the inability to imitate gestures and perform voluntary motor acts, on request or by a verbal command, due to an error in the configuration, the temporal pattern and the spatial organization of the members of the body in the context of the movement in question.

People with this type of apraxia can spontaneously manipulate tools and everyday objects, although sometimes this ability is also lost. The deficits caused by ideomotor apraxia seem to be the result of an interruption or a failure in the system that relates knowledge stored about the use of everyday objects and information about gestures, with the state of the body to produce the desired motor action or adequate.

Ideomotor apraxia causes in patients difficulties carrying out motor acts and simple movements (greeting someone or turning off a tap, for example), as opposed to other motor sequences or more complex movements (such as brushing teeth or getting dressed). However, unlike other apraxias, such as ideational apraxias, these people can verbally express these actions.

It is believed that this system is related to the areas of the brain that are most frequently damaged when this apraxia occurs: the parietal lobe left and premotor cortex of the brain.

Causes

Usually, the most common cause of ideomotor apraxia is ischemic damage (by spillage or stoppage of blood flow) in one of the hemispheres of the brain. There are multiple regions of the brain where injuries have been correlated with this type of apraxia.

Initially, it was suggested that lesions in the subcortical white matter tracts, the axons that extend down from the neuronal bodies in the cerebral cortex, could be one of the main causes responsible for the appearance of ideomotor apraxia.

It has also been suggested that lesions in the basal ganglia, a brain structure responsible for the initiation and integration of movements, could be another of the the possible causes, although there is debate today about whether damage produced only in this region of the brain could be enough to induce ataxia ideomotor.

However, it has not been shown that lesions in these subcortical brain structures are more prevalent in apraxic patients. The most recent investigations indicate that the damaged brain areas that have been most associated with patients with this type of apraxia would be: the parietal region, the left premotor cortex and the motor area supplementary.

Lesions in other types of brain structures, such as the hard body (the bundle of fibers that communicates one hemisphere with the other), could also induce apraxic symptoms, with variable effects on both hands. In addition, ideomotor apraxia also occurs comorbidly in Parkinson's disease, Alzheimer's dementia, Huntington's disease, corticobasal degeneration and progressive supranuclear palsy.

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Signs and symptoms

Ideomotor apraxia generates a whole series of symptoms that have a variable impact on each individual. Normally, this disorder affects the person's ability to carry out daily movements and actions such as greeting someone, for example.

Affected people often show errors in the way they hold and move tools and objects when trying to use them correctly. One of the most characteristic symptoms of ideomotor apraxia is the inability to perform motor acts under a verbal command. For example, if the patient is given a comb and instructed to brush his hair, the comb will execute the movement incorrectly, circling the head or holding the ball upside down. brush.

The errors made by patients with ideomotor apraxia can be of a spatial nature, as in the example of inappropriate use of the comb, and also of a temporal nature. Continuing with the previous example, the person would carry out the act of combing their hair in an excessively slow or erratic, showing signs of committing a motor act with errors in the temporal sequence.

Another of the most characteristic symptoms of ideomotor apraxia is the inability to imitate hand gestures, whether or not they have a specific meaning. Patients know what they have to do when someone asks them to, but they cannot correctly execute the gesture. This neurological disorder prevents affected people from performing any voluntary act and, in Sometimes, they can also lose the ability to carry out actions and movements spontaneous

In recent years, several studies have been able to verify that people with ideomotor apraxia seem to be unable to touch their fingers as quickly as a control group of healthy subjects. Also, apraxic patients are slower to aim at a target light when they cannot see their hand. It seems that these people are much more dependent on visual information when performing movements than healthy people.

Treatment

The impact caused by ideomotor apraxia on the autonomy and functional capacity of the person who suffers from it is variable and generally depends on what other types of disorders are associated. The repercussions of this neurological disorder on activities of daily living are varied.

With regard to personal hygiene: the person will have serious difficulties in orienting and correctly positioning toiletries, such as a comb, toothbrush or razor. Regarding eating, the patient will present difficulties to correctly grasp the cutlery when eating or to place the cutlery on the table, in the proper shape and space. You will also experience problems when dressing, putting on or taking off your socks, for example.

Although it is known that a small group of patients with ideomotor apraxia recover spontaneously, this is not very frequent. What can happen is the phenomenon of hemispheric compensation, for which the functions that one hemisphere normally performs could be performed by the other, if damaged.

Occupational therapy and neuropsychological rehabilitation They are the most common treatments in cases of apraxia, in order for the patient to recover the maximum functional capacity of it. Normally, you work by dividing daily tasks into separate components (for example, the act of combing their hair) and the patient is taught to perform each motor act individually and then complete the sequence complete.

The previous procedure is widely repeated, so that the person can recover the skill in the execution of a certain movement and, eventually, combine other sequences to create new movement patterns and unique.

Bibliographic references:

• Ardilla, A. (2015). Kinetic, ideomotor, ideational and conceptual apraxia. Neuropsychology, Neuropsychiatry and Neurosciences Magazine, Vol.15, Nº1, pp. 119 - 139.
• Sunderland, A.; Shinner, C. (Apr 2007). "Ideomotor apraxia and functional ability". Cortex. 43 (3): 359 - 367.
• Wheaton, L. A., & Hallett, M. (2007). Ideomotor apraxia: a review. Journal of the neurological sciences, 260(1-2), 1-10.