Constructional apraxia: symptoms, causes and treatment

Constructional apraxia is a neurological disorder that impairs the ability to build and draw.

Brain lesions can cause different disorders depending on the area that is affected and its severity.

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

One of the best known apraxias is constructive apraxia, in which there are difficulties in performing sequential movements.In this apraxia, there are difficulties in making detailed and organized drawings or assembling objects, which is the subject of this article. Let's see what it is about, which are its causes, symptoms and treatment.

What is constructional apraxia?

Constructional 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 a picture. the ability to perform the sequential movements necessary to assemble an object or draw a picture..

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

These difficulties are not the result of motor problems, such as tremors or Muscle stiffness, nor visual problems such as blindness. There is no loss of sensation, strength or muscular coordination..

Nor is there a deficit in understanding what needs to be done, i.e., the patient understands what actions should be done to, for example, assemble a cabinet. The problem is that he does not perform the sequence correctly and the action becomes disorganized.

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

Causes

Generally, constructive apraxia is the result of a brain lesion, usually in the right hemisphere, specifically in the right hemisphere.usually in the right hemisphere and, specifically, in the parietal and occipital lobes. This injury may be the result of a stroke, traumatic brain injury, stroke or cerebral ischemia.

It has long been known that visuoconstructive abilities, i.e., those that involve using the vision pathway to organize movements to construct objects, are represented bilaterally in the brain, but there is asymmetry in terms of their cortical organization.. It is the right hemisphere where there is greater specialization in visuoconstructive abilities.

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

When the lesion is in the right hemisphere, patients, when evaluated by drawing copy tests, tend to draw in a detailed way, but with difficulties in showing the spatial relationships between the parts of the drawing. On the other hand, when the lesion is in the left hemisphere, drawings tend to be less detailed, and are copied more slowly and with difficulties in tracing.

Although lesions in the parietal and occipital lobes are the most common, sometimes lesions can be found in the frontal lobe, and patients with lesions in the frontal lobe are more likely to have a more detailed drawing.Patients with lesions in this area usually present perseveration and planning problems in their drawings.

Symptoms

Depending on the area affected, whether it has occurred in the right or left hemisphere, and whether the lesion is severe or mild, the symptoms of constructional apraxia are highly variable. However, patients diagnosed with this type of apraxia generally, patients diagnosed with this disorder show the following symptoms:

• Difficulty or omission of the details of the drawing to be copied.
• When drawing a horizontal line, he/she does it in small pieces.
• Turns, inverts or rotates the figures.
• Changes the angles of the drawings.

Diagnosis

Diagnosis is usually made by a psychologist or neurologist.. The psychologist can administer different tests to know with more accuracy the characteristics of the constructive apraxia of the patient and the degree of affectation at functional level. By means of neuroimaging techniques, it is possible to find the lesion and its extension, relating it to the severity of what is seen in the patient.

Two types of tests specialized in the detection of constructional apraxia are usually used. 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 widely used, are the drawing tasks, in which drawing tasks, in which the professional orders the copying of a certain figure or verbally instructs the patient to draw something, such as a square, a circle, a cube, a circle, a cube, a cube, a cube, or a cube.such as a square, circle, cube, among other geometric figures.

Drawing tasks are the most commonly used in practice due to their low cost, since only paper and pens are needed.

The tasks of copying drawings not only allow us to know what are the artistic talents of the patient. They help us to see several 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 planning, memory, sequencing and attention.

Among the most commonly used drawing tests are the King's complex figure and the clock copy test.. The first consists of a figure without semantic meaning, that is, a very complex abstract drawing, while the second is the simple copy, either with a model or verbally, of a clock, something that the patient is understood to already know beforehand.

Treatment

The treatment of this type of apraxia is usually done through motor therapies and insisting that he/she fixates in more detail on the parts of the drawing. However, the best option is to intervene directly on the focus of the disorder, i.e. on the lesion, either surgically or by means of drugs.that is to say, on the lesion, either surgically or by means of drugs. A complete recovery does not usually occur in apraxias, although this depends on the location and severity of the lesion.

It is very important for the family to be involved in the recovery and give emotional support to the patient with this type of disorder so that he/she attends therapy and gets better.

The special case of dressing apraxia

Although it has traditionally been related to constructional 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 for dressing. However, it must be differentiated from dressing apraxia, it must be differentiated from constructive apraxia since the problems are related only to the acts of dressing.The patients with dressing apraxia are not affected in other areas such as the assembly of figures or the copying of drawings typical of the apraxia explained in depth in this article.

Patients with dressing apraxia are significantly affected in their autonomy: they put their clothes in the wrong order (e.g. jacket before shirt), they often manage to put on their clothes after several trial and error attempts and more complex actions, such as tying their shirt or lacing their shoes, are real odysseys.

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

Bibliographic references

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