Ideational apraxia: definition, causes and symptoms

This type of apraxia affects the ability to conceptualize and execute certain motor actions.

Ideational apraxia is a neurological condition that incapacitates the person to think and perform certain sequences of movements with everyday objects and tools, when asked to do so. and tools of daily use, when asked to do so.

For example, when we tell a patient suffering from this type of apraxia to communicate out loud the steps to brush his teeth, he will find it impossible.

Next, we will see in more detail what the ideational apraxia consists of, which are the causes and its main symptoms, as well as the indicated treatment.

What is ideational apraxia?

Ideational apraxia is a neurological disorder characterized by the loss of the ability to conceptualize, plan and execute complex sequences of motor actions involved in the use of tools and objects in daily life. complex sequences of motor actions involved in the use of tools and everyday objects.

This condition prevents the sufferer from planning movements in which there is some kind of interaction with objects, because there is a loss of awareness or perception of the purpose of the objects. The characteristics of this disorder include a disturbance in the concept of sequential organization of voluntary actions. The patient appears to have asked for knowledge of what a specific object represents.

It was the psychiatrist Arnold Pick who, a century ago, described the first patient who seemed to have lost the ability to use objects; this person made mistakes such as combing his hair with the wrong side of the comb or brushing his teeth with his finger, mistakes that usually occur in ideational apraxia.

However, it was not until the 1900s that the German neurologist Hugo Liepmann redefined the term ideational apraxia, specifically describing a series of disorders that involved, above all, problems in motor planning, apart from alterations in visual perception, language or the symbolic capacity of the patients.

Causes

The causes of ideational apraxia are still unknown to most researchers.

However, Studies of patients who have suffered brain damage indicate that this type of apraxia is related to lesions in the dominant hemisphere, in areas close to those associated with disorders such as aphasia.in areas close to those associated with disorders such as aphasia.

It was Liepmann at the beginning of the last century who proposed a hypothesis involving the motor processing system, in charge of executing actions, located in the left cerebral hemisphere and responsible for the motor planning that guides body movements. However, he was never able to describe in two patients with the same brain damage, the same type of symptoms characteristic of ideational apraxia.

Other researchers have pointed out that, possibly, damage to the lateral sulcus of the brain, also known as Sylvius fissure, could contribute to explain the impairment of object recognition by the subjects. Another possible location leading to the typical symptoms of ideational apraxia could be the marginal gyrus, located in the parietal lobe of the brain.

In general, ideational apraxia has been identified with bilateral lesions in parietooccipital and parietotemporal regions, although frontal and frontotemporal lesions in the left hemisphere have also been proposed as possible locations involved in the causes of this type of apraxia, as this would explain the problems in motor planning observed in this type of patients, as well as the difficulty in distinguishing it from certain aphasias.

In cases in which apraxia occurs together with some type of dementia (Alzheimer's or Parkinson's), extensive lesions in the left hemisphere and damage to the corpus callosum have been described.

Signs and symptoms

Patients with ideational apraxia, as mentioned above, are unable to perform movements involving an orderly sequence of acts. Although the person may be able to execute each act of those that make up a movement separately, they cannot execute them in an orderly and logical manner.

To test this, Liepmann performed a series of tests, known as multiple-object tasks. Each task required the patient to use more than one object; the investigator described the task to the patient and asked him or her to execute that task as described. Liepmann gave patients various items, such as a candle, a wick, and a box of matches. He then watched to see how they interacted with each object.

In the case of the matchbox, one of the patients brought the box close to the wick; another one opened the box and took out a match, and brought it close to the wick without lighting it; another patient struck the candle against the matchbox, and so on. The researcher was able to witness the discontinuity of the patients' actions with respect to everyday objects, categorizing the errors they made as: misplacement of actions, misuse of objects, omissions or sequential errors.

In short, the deficit presented by patients with ideational apraxia is not a lack of knowledge of how to use an object, since they understand perfectly well the function of each one of them. The problem lies in the fact that, when they try to interact with multiple objects to execute one of their functions, the execution becomes defective..

The person is thus able to perform more or less complex actions on a routine basis (lighting a match or opening a box), but is unable to do so under verbal command or when asked to do so. Hence, for some researchers, this type of apraxia is nothing more than severe ideomotor apraxia, which involves the inability to perform movements or gestures when these are required verbally or by imitation.

Treatment

At present, the most common treatment for apraxia is the most common treatment for ideational apraxia, which is still a brain damage disorder, is occupational therapy and neuropsychological rehabilitation.These are aimed at delaying the progression of symptoms and helping patients to regain their independence and functional autonomy.

In younger patients, after a stroke that causes an apraxia of this type, recovery is less complicated because their brains are more plastic than those of an adult or older person, so that as new patterns and behaviors develop during rehabilitation, functional and intact neuronal areas can take over some of the functions that were performed by the damaged regions.

Ideational apraxia has been frequently described in cases of dementia of the Alzheimer's type, being a major cause of morbidity and progressing with the underlying disease. In these contexts, people rapidly lose autonomy and become highly dependent, requiring the use of technical aids and, in the most severe cases, transfer to a center where they can meet their needs.

Bibliographical references:

• Ardila, A., & Rosselli, M. (2007). Neuropsicología clínica. Editorial El Manual Moderno.

• Hanna-Pladdy, B., & Gonzalez Rothi, L. J. (2001). Ideational apraxia: Confusion that began with Liepmann. Neuropsychological Rehabilitation, 11(5), 539-547.

• Ochipa, C., Rothi, L. J. G, & Heilman, K. M. (1989). Ideational apraxia: a deficit in tool selection and use. Annals of Neurology, 25, 190-193. doi: 10.1002/ana.410250214