Constructive apraxia: symptoms, causes and treatment

Brain injuries can cause different disorders depending on the area that is affected and how severe it is.

One of the disorders whose cause is this are apraxias, having multiple types depending on the symptoms and the brain area affected. Apraxias involve difficulties in performing sequential movements.

One of the best-known apraxias is constructive apraxia., in which there are difficulties when it comes to making drawings in a detailed and organized way or assembling objects, which is the subject of this article. Let's see what it is, what are its causes, symptoms and treatment.

• Related article: "Apraxia: causes, symptoms and treatment"

What is constructive apraxia?

Constructive apraxia is a disorder in which there is difficulty or complete loss of the ability to perform the sequential movements necessary to assemble an object or draw.

Patients diagnosed with this type of apraxia have difficulties in carrying out daily actions, such as assembling a piece of furniture or drawing a simple drawing on paper.

These difficulties are not the result of motor problems, such as tremors or muscle stiffness, nor are they the result of visual problems, such as blindness. No loss of sensation, strength, or muscle coordination.

Nor is it that there is a deficit in the understanding of what should be done, that is, the patient understands what actions should be done to, for example, assemble a wardrobe. The problem is that he does not carry out the sequence correctly and the action is disorganized.

Constructive apraxia can be identified by noting that the patient performs apparently simple tasks inefficiently and poorly such as copying drawings, building figures with blocks or assembling a puzzle.

Causes

Constructive apraxia is usually the result of brain injury, usually in the right hemisphere and, specifically, in the parietal and occipital lobes. This injury may be the result of a stroke, head trauma, stroke, or cerebral ischemia.

It has been known for some time that visuoconstructive abilities, that is, those that involve using the vision pathway to organize movements to build objects, have a bilateral representation in the brain, but there is asymmetry in their cortical organization. It is the right hemisphere where there is greater specialization in visuoconstructive capacities.

This does not mean that there are no patients with constructive apraxia who present lesions in the left hemisphere; however, the characteristics are different from those with the lesion on the right.

When the lesion occurs in the right hemisphere, the patients. When assessed through drawing copy tests, they tend to draw in detail, but have difficulty showing the spatial relationships between the parts of the drawing. On the other hand, when the lesion occurs in the left hemisphere, the drawings tend to be less detailed, and they are copied more slowly and with difficulties in the stroke.

Although lesions in the parietal and occipital lobes are usual, lesions can occasionally be found in the frontal, and patients with lesions in that area often have perseveration and planning problems in drawing.

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Symptoms

Depending on the area affected, if it has occurred in the right or left hemisphere, and the lesion is severe or mild, the symptoms of constructive apraxia are highly variable. However, Generally, patients diagnosed with this disorder manifest the following symptoms:

• Difficulty or omission of the details of the drawing to be copied.
• When drawing a horizontal line it does it in little pieces
• Flip, reverse, or rotate the shapes.
• Change the angles of the drawings.

Diagnosis

Usually, the diagnosis is made by a psychologist or a neurologist.. The psychologist can administer different tests to know more accurately the characteristics of the patient's constructive apraxia and the degree of involvement at a functional level. Using neuroimaging techniques, it is possible to find the lesion and its extent, relating it to the severity of what was seen in the patient.

Two types of specialized tests are usually used to detect constructive apraxia. On the one hand, there are the assembly tasks, which consist of building blocks and assembling two and three-dimensional models, such as puzzles, tangram figures or models. On the other hand, and being more used, are drawing tasks, in which the professional orders a certain figure to be copied or verbally tells the patient to draw something, such as a square, circle, cube, among other geometric figures.

Drawing tasks are the most used in practice due to how economical they are, since it is only necessary to have paper and pens.

The tasks of copying drawings not only allow us to know what the artistic gifts of the patient are. They help us to see various cognitive aspects, such as visual perception, the ability to differentiate between the background and the figure, spatial organization, vision-hand coordination. In addition, it allows us to observe how planning, memory, sequencing and attention occur.

Among the most used drawing tests we find the complex figure of Rey and the proof of copying watches. The first consists of a figure with no semantic meaning, that is, a very complex abstract drawing, while the second it is the simple copy, either with a model or verbally, of a watch, something that is understood that the patient already knows with anteriority.

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Treatment

The treatment of this type of apraxia is usually done through motor therapies and by insisting that he pay more attention to the parts of the drawing. Nevertheless, the best option is to intervene directly on the focus of the disorder, that is, on the lesion, either surgically or through drugs. Normally a complete recovery in apraxias does not usually occur, although this depends on the location and severity of the injury.

It is very important that the family is involved in the recovery and give emotional support to the patient with this type of disorder so that they go to therapy and improve.

The special case of dressing apraxia

Although traditionally it has been related to constructive apraxia, dressing apraxia presents a series of particularities that differentiate it.

This type of apraxia has been related to an alteration of the body schema and a deficit in the movements necessary to get dressed. Nevertheless, it must be differentiated from constructive apraxia since the problems are related only to the acts of dressing, and not in other areas such as the assembling of figures or the copying of drawings typical of apraxia explained in depth in this article.

Patients with apraxia of dressing present their autonomy significantly affected: they put their clothes in the wrong order (eg, jacket before jacket). t-shirt), they often manage to put on their clothes after making several trial and error attempts, and more complex actions, such as tying their shirts or shoelaces, are true odysseys.

This type of apraxia can be accompanied by constructive apraxia, and it has been related to lesions in the temporoparietal cortex of the right hemisphere and anterior cingulate cortex.

Bibliographic references

• Garcia, R. and Perea, M.V. (2015). Constructive and dressing apraxia. Neuropsychology, Neuropsychiatry and Neurosciences Journal, 15, 1, 159-174.
• Greene, J.D.W. (2005). Apraxia, agnosias and higher visual function abnormalities. Journal of Neurology, Neurosurgery & Psychiatry; 76:v25-v34.